Wednesday, September 30, 2009

DTC Marketing: It's Out of Control!

Once upon a time, there was a patient who experienced debilitating back pain (No this isn't about the Wizard of Oz). So after many years of avoiding surgery, the patient decided to visit the Surgeon. The patient came prepared with the latest and greatest internet press releases on Total Disc Arthroplasty, and declared that he knew that he was a viable candidate for a TDA, sometimes this is known as a self-diagnosis.

The surgeon, being an exceptional clinician, worked up the patient using various imaging options to discern that the patient wasn't a candidate for TDA. Unhappy with the surgeon's diagnosis, the patient was intent on finding someone that would be willing to perform the procedure. The patient told the Surgeon, that since it was on the internet, it must be new, it must be true and it will make a difference.

Unfortunately, after seeing three more surgeons, the patient was told that he was only a candidate for a fusion. So what's the moral of the story. It's time the industry gets a grip on the insanity of Direct To Consumer Marketing, aka DTC. Consumer Driven Healthcare will never work, neither will DTC. Yet, let's look at the insanity.

Stryker hires Jack Nicklaus to talk about the his new hip. Are consumers that gullible, that they believe that by going into their surgeon's office and telling them what to use, that the surgeon is going to use a Stryker Ceramic-on-Ceramic Hip when they were trained on a Biomet System? Does the patient believe that they will be a champion golfer like Jack? Or, if it was good for Jack, it must be good for me!

Let's look at Erectile Dysfunction! I realize that this blog isn't about spine, but we do work in a rigid environment. How many Cialis commercials do my kids have to sit through when watching a football game or golf tournament. Are there that many American men that experience ED? Just look at the demographics of these two viewing groups. In all likelihood they fall into the category that has heart disease, have had a recent heart attack, experience high or low blood pressure, have liver or kidney disease, stomach ulcers, are hemophiliacs, have sickle cell anemia, multiple myeloma, retinitis, and penile deformation. I guess this rules out 90-95% of the viewing public. But here's the kicker, if our male readers needed Cialis, would you be sitting there with your girlfriend or wife watching the sunset in separate bath tubs? Not on my life.

So here is my advice to the FDA. When November comes around and you spend two days listening to medical device and pharmaceutical companies lobbying for less restrictions on DTC marketing, line them up in firing squad fashion, and send them home wagging their tales. It was just a few years ago, that Tony Viscogliosi was declaring that the majority of patients getting fusions would create the brave new world of total disc arthroplasty. JP Morgan jumped on the band wagon, and declared, this product segment a future grand slam investment. Those analyses only served the person making those comments. Today, we are still debating reimbursements on total disc arthroplasty. Just imagine having to sit through 500 pedicle screw commercials?

So in closing, all this information makes physicians lives much more difficult when it comes to taking care of their patients. As I have argued in previous blogs, the patient as a healthcare consumer is not like a consumer shopping for a car or buying a rug. The Spine Blogger wants to know what our readers think?


  1. You miss an important fact when you mention the example of Jack Niklaus and Stryker. The patient does not go to a (for example) Biomet doctor and ask him to use Stryker...instead the patient goes to the Stryker website and goes to a doctor who implants Stryker. The doc gets the patient, the patient gets the Stryker hip, and the company get the business. I think this could work.

  2. It would be interesting to evaluate how many patients really do that. Obviously, many of the people that I socialize or have grown up with would never even do that, considering the amount of surgeons that have been paid by Stryker to promote their products. Remember, you look at it as Stryker promoting a Stryker surgeon, others look at it as a Surgeon promoting Stryker, and why? All for the love of a consulting fee!

  3. I have to agree with MM here. If this patient were me, I would consult with friends and family or others that I know that could refer a surgeon that they felt comfortable with. I certainly couldn't care less what they used on Jack Nicklaus or Randy Johnson. DTC marketing should be reserved for commodity items sold directly to the consumer. Otherwise, you empower people to think that they are smarter and know better than a trained surgeon.

  4. DTC marketing is a damn sight better than inducement marketing which pervades this Godforsaken business.

    To a certain extent DTC helps educate the consumer what options are available out there for treatment. While no doctor worth his salt should take a patient's word for what treatment should be given, at least the patient is getting involved in the process.

    Have we not all seen the recent ad campaign urging patients to ask their doctors questions? Is that all lip service as well?

    Smart companies find ways to get their products into the public mind. DTC is a useful tool to accomplish such a thing.

    At least an ethical businessman can wrap his head around successful marketing techniques and advertising. It is nigh near impossible to wrap one's head around the subterfuge and illegal activity taking place every day at strip clubs, Las Vegas, hotel lobbies, etc, etc, etc, on a daily basis in many other aspects of this industry.

    Bring on the sunshine act!!!!

  5. On the flipside, there is sometimes the patient who is actually a good candidate for a procedure such as TDR, however the surgeon subtly convinces the patient they are not. While there may sound clinical reasoning for the surgeon’s opinion, there may be other factors influencing the surgeon’s decision:

    1. Lower reimbursement
    2. Difficulty in getting the procedure reimbursed
    3. Not being trained on the device
    4. Device influence (Company consultant, friends with rep, distain for one company, etc…)

    Although we hope that all surgeons really do what’s best for their patients, in reality this is not entirely the case. In most situations, patients don’t have nearly as much clinical background to really know the difference. After all, the doctor knows best right?

  6. Is it possible to subvert the 1st Amendment to the Constitution with an Act? Even the Medical Device Act?

  7. Musculoskeletal Man, thank you for this great article. I frequent your blog often and your insight into spine and orthopedics is much appreciated.