 |
 |
The source of this article is the Naples Daily News: http://tinyurl.com/ag9rq 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. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn