Reading the newspaper this morning, I was struck – maybe “hit in the face” is better – by a full-page ad for electron beam tomography (EBT). The headline said, “This may be the most important ad you’ll ever read,” and the main message was that “your doctor will confirm” that EBT will either give you peace of mind or save your life. The copy ended with “Can you think of a reason you shouldn’t call for your appointment today? Good. We can’t either, and we look forward to seeing you for your fast, painless and affordable heart and lung BodyScan.”

I don’t know about you, but I’m certainly impressed. At last, a test with no downsides. No false-negatives. No false-positives. No chance of unnecessary procedures to follow up a suspicious finding. Nothing but guaranteed peace of mind or life-saving intervention. Heck, it’s even affordable. I sure can’t think of any reason not to make an appointment. Can you?

The driven-consumer health system

We hear a lot these days about the evolution of the consumer-driven health care system. In FPM a little over a year ago, for instance, Norman E. Vinn, DO, commented that, with more of the cost of health care ending up on the patient’s shoulders, “the incremental value of each new advance must be proven to individuals as well as to insurance companies and government regulators” (see “The emergence of consumer-driven health care,” January 2000, page 46). I’m sorry if I’m being cynical, but I suspect that the newspaper ad I saw today will count as proof of the “incremental value” of EBT to a lot of readers. If you have some of these readers in your practice, chances are they’ll be calling – unless, of course, they self-refer, pay the affordable price of peace of mind out of their pockets and head straight to a cardiovascular surgeon with their film. Come to think of it, why should they call you? After all, why should they pay you a hefty $10 co-payment when the ad makes it clear that all you’ll do is confirm the value of EBT?

I’m all for advertising, in its place. But its place is before the eyes of a knowledgeable audience. Most Americans are reasonably well-equipped to evaluate ads for cars, cake mixes, cruises and cell phones, but we just aren’t trained to spot the hooey in ads for high-tech medical interventions. How many of your patients would be surprised to hear that high-tech diagnostic tests aren’t infallible, that high-tech imaging doesn’t see all there is to see or that the newest drugs don’t invariably cure and may actually make matters worse?

How on earth can a consumer-driven health care system function if ads like this are driving the consumers? Direct-to-consumer advertising for pharmaceuticals is bad enough, even when the FDA requires advertisers to include package-insert information. There, at least, you the physician (lucky you!) stand between the patient and the wonder drug advertised. As long as you don’t mind imperiling your relationship with the patient, you have a chance to explain why the new superdrug might not be what the patient needs. The ad for EBT, on the other hand, invites me to make my own appointment, bypassing whatever advice you might give me.

Big-time patient education

If I had the nation’s educational system to make over (God forbid!), I would insist that nobody could graduate from high school without demonstrating a thoroughly internalized understanding of how advertising works its magic, where the gray areas are in medical diagnosis and treatment and what probability statistics really mean in contexts ranging from positive and negative predictive value through relative risk all the way to games of chance. (OK, gambling is off the subject, kind of. Unless you think of betting the cost of an EBT scan on the chance of a lifesaving finding.)

No, that’s not going to happen. And because it isn’t, today’s high-school graduates – and today’s college graduates, for that matter – have an educational deficiency. One you’re equipped to help fill. Are you working on it? Granted, there’s not much time in a 15-minute visit to help the patient develop a mature understanding of medicine, but what would it be worth to you to have patients who are more skeptical of the advertisements they bring in to ask you about? What would it be worth to have patients who understand that the typical drug affects the body in a variety of ways, not just the one way that led you to prescribe it? What would it be worth to care for a bunch of educated consumers? Something to think about.

Yeah, I know. It will never happen. In the meantime, for my own peace of mind, I’ll just fold up the ad for the “miraculous new technology” called EBT and send it off to the Federal Trade Commission.