" ...the FDA, in its questionable wisdom, has also permitted the drug industry to advertise the product without ... (being) required to list the possible side effects."
Good-bye Joe Camel! Anyone living outside a cave has been bombarded by the news that the tobacco industry has been under siege. The government is now feeling the strength of "public opinion" and the knowledge that the time is right to make the move against the tobacco industry. There are many issues to be discussed in this debate: constitutional issues dealing with commercial free speech; boundaries of individual responsibility of the person who smoked and ultimately developed cancer; the flagrant manipulation of the mind so cleverly depicted in advertising the great outdoors and the "freedom" and "macho" images engendered by smoking one brand over another, or the feminine "liberation" and "equality" fabricated by the advertising specifically directed at women. We will not mention the unconscionable advertising targeted at youngsters and the image of "fun" and "sex appeal" portrayed in the creative marketing for tobacco.
There is another movement, however, gaining momentum and slowly and insidiously invading the minds and homes of every resident in America. That new industry demon is the recent United States Food and Drug Administration opening the nation's airways to a deluge of advertising by drug companies. In the event you have not been watching your television, the extraordinary decision by this government agency to permit drug advertising has literally transitioned television into being part of a virtual "drug cartel."
For some, like those in the advertising industry or for those who own television networks, the revenue will translate into literally hundreds of millions of dollars, perhaps designed to replace, with incredible precision timing, the loss of income from tobacco revenues. For the unsuspecting television viewers, however, it has now created a market which will generate a confusing subliminal drug message which is at odds with the intent of the government's "war on drugs" program.
Even more significant is that the FDA has provided the drug companies with a medium that is exceptional in its ability to portray the product either on an emotional level, or to produce an impulse reaction, which translates into greater utilization of the product. In addition to providing the ability to do this, the FDA, in its questionable wisdom, has also permitted the drug industry to advertise the product without the same level of responsibility imposed on most other products: namely, they are not required to list the possible side effects. Peculiar? Yes. Bizarre? Yes. Inexplicable? NO!
The clout of the pharmaceutical industry is legendary. It is perhaps the most legitimate, organized, wealthy, and potentially dangerous group in the history of the nation. Despite the fact that the drug industry has been "exempted" from advertising the side effects of drugs, as anyone who has ever read the "adverse reactions" will attest, they range from allergic reactions to impotence, from convulsions to death. The drug industry has been given a temporary reprieve from social, ethical and moral responsibility. When the regulations are changed, however, and the industry is forced to advertise the adverse side effects of the drug, I can hear the announcer now, in the typical rapid staccato style used by the automotive industry when announcing the "qualifiers" when purchasing or leasing an automobile; talking so fast the human ear cannot hear the message and the human brain cannot process the data fast enough to make sense of the message.
More importantly, however, if the adverse effects are mandated to be disclosed, it will take less than six months before the general audience becomes desensitized to the message, and it will then be meaningless. It will have been assimilated. How many of you have flown and have memorized the important script of the flight attendant, while not hearing the importance of the message?
The nation's physicians have written in their publications that they are opposed to the new policy, because it will release a deluge of calls to their offices by patients demanding product "X" as seen on "Oprah," or the new medication "Y" as seen on the "Evening News with Dan Rather." I believe this protest is disingenuous, however, because it simply replicates the very model of yesterday in which the doctor was provided the information by drug detail salespersons bearing gifts, and it was the physician who made the suggestion. Now it is patient driven. The difference is merely in the amount of money shifted from doctor gifts to TV advertising.
It is estimated that drug companies spend an estimated 800 million dollars annually advertising prescription drugs. That figure will provide some perspective on how much is really required to "get the message out to the public." The chiropractic profession attempting to do a national message campaign on pennies is an exercise in futility, and one which could better "target" directly those limited funds to a more immediate return on investment.
As we reflect on the fact that there are approximately 8,000 deaths annually from accidental poisoning by drugs, improper utilization, and misprescribing by professionals, the total becomes significant, yet acceptable. Yet when the one in a million probability of a stroke occurring following a cervical adjustment is discussed, the numbers are unacceptable. Double standards are at work in the media, the scientific community, and the public.
The drug industry will certainly not admit that they are motivated to advertise their products because of their increasing revenue from the growing utilization of drugs, any more than the tobacco industry would admit to increasing the levels of addictive ingredients to "hook" the end user on the product, not to mention the billions of dollars in profit from the product sale.
On one hand, we have launched a "war on drugs" and spend approximately $1.5 billion in federal funds to help reduce the utilization of illegal drugs; on the other hand, we have now opened up the floodgates of increased and indiscriminate utilization of legalized drugs by abandoning the control of the most powerful medium of advertising in history ... television. If creating greater demand for drugs was not the object of advertising, what other possible motive could be behind the excitement to pronounce the "miracle of the moment" on prime time television?
There is a simple lesson to be learned for chiropractic from the tobacco disfavor and drug advertising euphoria. The marketplace is changing, and the marketplace will create the demand or fuel the demise of any and every product or service. If chiropractic is to survive in the marketplace, it will have to create a positive image, a marketplace demand, and a service which is perceived by the public as valuable. Unless and until the chiropractic profession's image is consistent with the market, it can either "go up in smoke" as did the tobacco industry, or be viewed as valuable and necessary service for the health care needs of the public. Image is everything, and the collective image of chiropractic is developed from every facet of the profession. With each encounter, positively or negatively, the public image and perception is formed.
It all goes back to a basic demand to produce and provide a service to a public that is willing to pay for that service, willing to support and demand the service, and willing to fight for the right to choose that service. Chiropractic needs only to concentrate on what it has done best for the past 100 years to accomplish that objective: getting sick people better, less expensively and more quickly than the nearest competitor. Can we do that? Yes! The question is, will we?
We must reverse the PR mentality which espouses a "quick fix" on the tube as the solution to the problems facing the profession, and concentrate once again on the patient. I believe it is not too late to regain the confidence and patient support which the profession enjoyed to a much greater degree in years gone by; the marketplace will make the right decisions.
Louis Sportelli, DC
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