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< | An Initial Diagnosis | >
> | The Doctor, the Pill, the Website | | | | |
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< | A generation ago, your local doctor had it relatively easy. For the most part, a few know-it-alls aside, his patients would pretty much trust him and listen to his advice. After all, he was a professional and they weren’t. He knew the rules of how the body worked and they didn’t. So when he applied those rules, they listened to him and deferred to his professional discretion. That was the old relationship. | >
> | It seems fairly obvious that doctors, who are relied upon to choose the best course of treatment for their patients, and pharmaceutical representatives, who simply intend to sell their products, should eat lunch separately. But for years, doctors and pharmaceutical representatives have been sitting together, typically with doctors eating from drug reps.’ hands. We may imagine that doctors were less troubled than patients were by this relationship; many doctors may have acknowledged that although they were being lobbied, that fact would not result in different, inferior treatments for their patients. This may have been true since they were their patient’s primary source for medical information and thus, they still retained the discretion to decide whether to prescribe the drugs that were being pushed on them. But now, due to the growth of the online healthcare market, the former is no longer the case, and as a result, neither is the latter. Websites, not doctors, are increasingly becoming the primary sources of medical information for healthcare seekers. And as potential patients come to “their own” conclusions about what treatment they need and desire, doctors’ ability to exercise their discretion to decide what treatment patients ought to undergo is consequently disappearing. True doctors, concerned with choosing the best course of treatment for their patients, have all but lost their seat at the table. | | | | |
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< | The internet has changed the basic doctor-patient relationship. Now before or instead of visiting a doctor, many patients are attempting to self-diagnose their ailments with the help of online sources. Of course, like with any educational information, the widespread online publication of biomedical literature is a good thing. If people want to spend their free time reading PubMed, the world will probably be the better for it. But as things have developed thus far, the online proliferation of user-friendly diagnostic information, a cure for ignorance, has been accompanied by more than a few adverse side effects. | >
> | Pharmaceutical Capture of the Online Healthcare Market | | | | |
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< | The capture of online medical websites like WebMD by pharmaceutical companies is problematic, but it is not new. It can roughly be understood as a simple continuation of the capture of a large portion of the non-online medical community by those same pharmaceutical companies. Cyberchondria, on the other hand, is both problematic and new. Referring to the extreme hypochondria exhibited in some users of medical websites, cyberchondria is an example of a new complication affecting the basic doctor-patient relationship. Furthermore, healthcare providers have noted that medical websites regularly confuse or worry patients and undermine doctors’ authority. Thus in some ways, the doctor in the digital age has a relatively harder job. He encounters more patients who are resistant to his advice and his professional discretion is generally afforded less credence than his predecessor’s. But while the basic doctor-patient relationship has surely changed because of the internet, that doesn’t mean the doctor in the digital age will necessarily be a less effective healer. Not at all. In fact he has the potential to use technology to drastically increase the efficacy of his practice. | >
> | Pharmaceutical capture of the healthcare industry has been a pervasive problem, with wealthy drug companies controlling lawmakers, advertising opportunities, and despite some restrictions and standards, doctors’ attention. In theory, the growth of the online healthcare market—the increasing presence of online medical information sites and self-diagnosis tools—could have threatened drug companies’ stranglehold on medical information. That is because low-cost, doctor-developed healthcare websites could have given doctors an avenue through which to share their unbiased medical knowledge with patients: a potentiality which would have essentially lowered patients’ costs of interacting with doctors and would likely have strengthened doctor-patient relationships in general. But this has not been the case. Instead of doctor-developed healthcare websites, the online healthcare market has evolved as a place where a few, highly-trafficked sites are maintained on behalf of pharmaceutical companies in order to dominate patients’ attention. | | | | |
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< | It is unsurprising that stakeholders in medical websites have suggested expanding the use of those sites. Similarly, it is unsurprising that major technology developers have seen the potential inherent in streamlining the delivery of online medical information to internet users. Yet while a variety of other players have begun to make use of the online medical information community, healthcare providers have been slow to join the fray. Perhaps this too is unsurprising; like other professionals, doctors as a group often lack technological expertise and tend to err towards the traditional in their conception of patient relationships. But for a profession where a duty to provide the best available care is owed, that does not make an apathetic approach to new solutions excusable. Too many doctors believe that the optimal function of the internet is simply to give healthcare providers access to new information, or to allow doctors to e-mail patients their test results. These doctors apparently do not see the internet’s vast potential to provide genuine patient education and more. Or alternatively, they lack the initiative to take ownership of the online medical information community and thereby transform it into an eminently useful treatment platform. So long as the internet’s potential goes untapped, these doctors will continue to see their jobs become more difficult and their patient relationships grow more strained as they skirt the boundary of violating their Hippocratic oaths. | >
> | The most popular of these websites for instance, WebMD? , previously headed by a former Pfizer chief executive, and now run by a former Merck & Co. executive director, is admittedly connected to pharmaceutical advertising. WebMD? and similar sites offer advisory articles and easy-to-use diagnostic tools that unsurprisingly, tend to recommend the use of certain drugs. These websites will not always advertise the drug outright, and will less frequently note that the advice is coming from the drug manufacturer, but they will promote their sponsor’s product. By means of analogy, if banners and pop-up ads are the equivalent of drug commercials on TV, then WebMD? and websites like it are something like Dr. Oz: a source many patients will look to for information, perhaps being guided by an underlying desire for entertainment, or just an easy answer, while often not realizing they are in the middle of a product pitch. | | | | |
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> | The Minimized Role of Doctors | | | | |
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> | The growth of the online healthcare market has led to a minimized role for doctors. For patients, obtaining information from a doctor is costly and time-consuming whereas obtaining information from a website is free and instantaneous. With healthcare websites offering free, quick, and compelling diagnoses derived from a seemingly encyclopedic information database, it is unsurprising that healthcare seekers are increasingly finding online self-treatment preferential to and more trustworthy than a doctor’s treatment. While it is true that the actual administration of many treatments, pill prescription or surgery for example, can only be performed by a doctor, given the necessity of a patient’s complicity in undergoing a treatment and patients’ ability to shop for doctors, doctors’ roles have increasingly shrunk. That is, because doctors diagnostic abilities are now trusted less by their patients, because they cannot typically force their patients to accept a course of treatment they prescribe, and because patients retain the ability to find a doctor that will give them a desired course of treatment, doctors have lost nearly all of the bargaining power they previously retained in their patient relationships. Less and less do doctors maintain discretionary authority to prescribe a course of treatment; their role has been minimized and consists now, mostly of treatment administration—pill pushing and physical manipulations. | | | | |
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< | Through this point, my primary response to the draft was that it
fell into two segments, imperfectly coordinated. In the first, the
use of the medical information flow in the net by the pharmaceutical
molecule merchants is the subject. They have the wealth to buy up
the new media, as they bought up the old ones, leading to the
television-advertising nightmare in the US, for example. In the
second, the relative passivity of the physicians in using medical
education to improve treatment of their own patients is described.
The connection between the first and second, however, which has to
do with the overall capture of delivery by pharma and the reduction
of physicians to pill pushers on the clock, is not described. | >
> | A Warning to Other Professions? | | | | |
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A Second Opinion
A generation ago, your local lawyer also had it relatively easy. For the most part, a few know-it-alls aside, his clients would pretty much trust him and listen to his advice. After all, he was a professional and they weren’t. He knew the rules of how the legal system worked and they didn’t. So when he applied those rules, they listened to him and deferred to his professional discretion. That was the old relationship. Like the doctor in the digital age, the lawyer in the digital age has to acknowledge that his profession has changed: among other things, his client relationships begin from a new default position, his professional opinion means something different than it used to, and as a result, the use of technology will be pivotal to both the efficacy of his practice and the satisfaction of his ethical obligations.
The changing social structure and behavior of the health care system
of the US, as we moved from small-businessmen-doctors and a rich but
subservient pharma, to a managed care universe in which doctors are
employees on the clock and pharma owns more than anyone else, are
the implicit subject of part one. This brief part two deals with a
profession differently organized and therefore differently affected
by the changes we are considering.
So my overall response to the draft is that it tries to do too much
in 1,000 words, and would do a far better job of less. Less would
also be capable of trenchant and brief statement at the outset,
involving the presentation of a single new idea to the reader, who
could then follow its development through the line of the essay,
which is not, as I have tried to show, very easy now.
-- NigelMustapha - 30 Nov 2014 | | | \ No newline at end of file | |
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> | As much as the troubles of one profession can serve as a warning to other professions, the minimized role of doctors as a result of pharmaceutical capture of the online healthcare market should serve as a warning to other professions, lawyers included. When the balance of power in a professional relationship relies on the client’s deference to professional discretion, the professional’s power can be displaced by any other factor which attracts the client’s deference. Online interfaces are generally, increasingly capturing the attention of potential clients of all sorts. When the online interfaces that receive the most attention are themselves captured by groups with interests adverse to the professionals working in the same field, like in the case of the online healthcare market, balances of power will be shifted. |
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