Thursday, July 31, 2008

"Ask Your Doctor," "See Your Doctor"

So run taglines on ubiquitous pharmaceutical commercials. One ad even goes so far as to say, “If you have an erection lasting more than four hours, see your doctor.” Chances are your doctor will see you because he/she has never seen a four hour erection.

If I were the doctor, I wonder how I would handle the problem. Is there a known antidote? Would a bucket of ice water do? Do I refer this rare rigidity problem to an urologist who knows about priapism? Do I go to the Internet? I just googled for an answer and didn’t find any in medical texts.

According to Slate Magazine, a non-medical publication that usually only talks of political resurrections, says of a four hour erection,

”At least 38 men who have taken Viagra have gone blind, and the drug's manufacturers said it would consider adding a warning to the label. Drug companies already warn consumers that Viagra and competitors like Levitra and Cialis have several other side effects, like blurred vision, headaches, indigestion, and painful erections that last four hours or more. What do you do with an erection that won't quit?”
“Call your doctor—and be very, very afraid. Though the makers of erectile dysfunction drugs list prolonged, unwanted erections as a potential side effect, urologists have their doubts.
Priapism, a rare condition defined by prolonged erections in the absence of sexual arousal, is associated with certain blood diseases, hypertension, and recreational drug use. No matter what its cause, priapism can be dangerous if left untreated. A man who has a painful erection for more than 12 hours is at high risk for permanent damage.”
I don’t want to make too much fun of this. It is no laughing matter when blood for your brain and other vital structures pools in another organ..

Besides, the idea of asking or seeing your doctor for every possible side-effect is a serious business.

I don’t blame the pharmaceutical industry. What they advise is a safe and easy thing to do, and it’s good malpractice cover. Moreover, it may flatter some doctors to be asked. But, sad to say, doctors don’t know everything. And doctors may be a bit irritated spending time answering questions posed by the pharmaceutical industry, or feeling pressured to prescribe every pill that alluring Pharma ads recommend.

I suppose it all comes down to a matter of patient-doctor trust, which, according to a recent NYT article, is slipping with ¼ of patients saying they distrust their doctors. This may be because, given declining reimbursements, doctors can’t afford to spend more than 8 minutes or so per patient. One suggested solution is to have patients show up with a list of questions – no more than three please. Most doctors don’t have the time to go through the complete list of side-effects or contraindications rolled out on those ads or on medical websites.

I suppose the doctor could say, ask your drug manufacturer or their lawyers, or I can’t protect against all eventualities listed by the drug manufacturer, but that would be tacky and might destroy the image of the all-knowing, all-seeing, and all-answering doctor.


Tara Parker-Pope, “Doctor and Patient, Now at Odds, “ New York Times, July 29, 2008.


RiverPoet said...

Brilliant post! As a healthcare consumer, I can tell you that I'm very tired of the ads, especially when the doggone Levitra/Viagra/Cialis commercials pop up (ahem) during my favorite television shows.


Richard L. Reece, MD said...

Anyone who calls me "brilliant" is either smoking something or is possessed with uncommon insight.

Anonymous said...

replica watches amalgamate backbone and a archetypal faculty of appearance and can be beat just as calmly with a clothing as out on a captain boat. You could baddest the replicas of acclaimed timepieces such as the Seamaster, the Constellation, or the Chronometer, and accomplish the a lot of of all the specialized capabilities that these display.