Guest commentary: Creating false hopes for profit
On the dangers of TV ads about disease.
By JOSEPH H. FRIEDMAN, The Providence Journal via SHNS
June 3, 2005
A few months ago, I was inundated by patients asking if I hadn't
misdiagnosed them with Parkinson's disease when what they had was
normal-pressure hydrocephalus (NPH).
I had, by chance, seen a TV magazine show with a segment on NPH, and so
presumed that they or their family had also seen it.
When I saw the TV show, I figured that I was in for trouble, but how many
people, I wondered, would have seen it? Alas, the show was only the foot in
the door for an avalanche of TV advertisements about this disorder. In
retrospect, I wonder if the TV show wasn't actually part of the advertising
campaign ? like product placement in the movies.
NPH is a very rare malady, of unknown cause, with unknown pathology and no
agreed-upon diagnostic criteria. "Normal-pressure hydrocephalus" describes
what used to be called water on the brain. It is treated with the insertion
of a thin tube, called a shunt, which has a valve in it to control the
fluid flow.
The NPH ads are paid for by the shunt manufacturer, of course. However,
unlike the ads for medications, which are nefarious enough, these ads are
for a disorder that affects about one person per million per year.
Worse is that the NPH ads ask the patient to question the diagnosis that
their doctor has given: "Maybe you don't have Parkinson's disease ? maybe
you've been misdiagnosed and have been treated incorrectly for several
years. Maybe you can be cured!" Imagine telling cancer patients via TV ads
that maybe they don't have cancer ? that their biopsies should be
re-analyzed with the "cancer detector magnetic spectrometer": the space-age
diagnostic device too new and revolutionary to be approved yet. "Many
patients have stopped their chemotherapy and gotten their lives back in
order as a result," the ads might say. "Ask your doctor to check on this
new and exciting technique."
It is common to grasp at straws when drowning. No one wants to have
Parkinson's disease, or any other disease, but how often do we see
advertisements on television telling patients to ask for MRIs or CAT scans
to be "sure" they don't have some specific rare disorder? I have no idea
how many needless MRIs have been performed in the last few months because
of patient requests. More worrisome still are the number of shunts inserted
into elderly brains to treat Parkinson's disease, Alzheimer's disease, or
the host of other disorders often mistaken for NPH.
It would be very interesting to track the change in the number of shunts
inserted since the TV ads began. It would be more interesting to check the
outcomes in these patients.
I am very much in support of empowering the patient. I explain to my
patients how I reached a diagnosis. I try to explain to every Parkinson's
patient that there is no test to diagnose the disease. Imaging tests appear
normal in PD, so they are done only to find something else, and most of the
entities that mimic PD can't be diagnosed on imaging, either.
I tell patients who have clear-cut "classical" idiopathic Parkinson's that
an MRI is not only not useful but also possibly counter-productive ? since,
if the MRI shows an abnormality, it will be a new problem, unrelated to the
Parkinson's. I rarely want to find out this sort of thing. It's almost the
same as ordering a brain MRI on someone without neurological problems.
When patients ask me to prescribe an MRI because a TV ad suggested it, I am
upset. First, there is the obvious presumption that I overlooked this
possibility. In some ways this is amusing. I've published papers and
commentaries on NPH, and given talks on the subject. More impressive is
that I've correctly diagnosed the condition; that is, patients have
experienced sustained improvement after shunting.
I actually don't mind patients' asking me if they might have NPH. "Dr.
Friedman, I saw this show/ad on TV and wonder if I really have NPH and not
Parkinson's disease. What do you think?" I then tell them what I think:
that the dirtbags who run the shunt company, the increasingly politicized
U.S. Food and Drug Administration, and the executives who run television
are willing to create false hope if it creates a market.
Joseph H. Friedman, M.D., a neurologist, is editor of Medicine &
Health/Rhode Island.
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