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The doctor knows nothing

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Peter Kelly
Peter Kelly


I RECENTLY wrote an article suggesting that we should ban all advertising and marketing of medicines and drugs to help combat antibiotic resistance.

I don’t think this will ever happen, but I will try to explain my position a little further.

When you look closely at the marketing and advertising of medicines, there are a few recurring themes.

Drugs are always presented as being fast-acting, very effective and capable of delivering instantaneous results so patients need never suffer any inconvenience to their daily lives.

In reality, this is not the case. If you are inflicted with an ailment, cough, cold, sore throat, insect bite, cold-sore etc, you are going to be inconvenienced, it’s going to take roughly a week to resolve itself. And there is no medicine that will give you instantaneous results.

Now the marketing and advertising people are very clever, they don’t say you will get instantaneous results as that would be misleading. So instead they say things like, ‘fast acting,’ ‘nothing acts faster,’ and then they use fancy graphics and images. A typically graphic will be an arm with an area of inflamed skin, a cream will be applied to the inflamed area and inflammation will disappear. Red is used for discomfort. You will see a graphic of a stomach, everything is red and nasty looking, drug enters stomach and everything calms down and changes colour to blue.

This message is very persuasive and this is how a large percentage of the general public perceives the reality of how drugs work. This creates unrealistic expectations: people expect if they take a drug for an ailment the drug should solve the problem straight away. And when it doesn’t, they lose faith in healthcare professionals because they believe we gave them the wrong drug.

“That doctor knows nothing,” is a phrase every pharmacist has probably heard from a patient at one time or another, but it’s worthwhile looking more closely at how this plays out.

Patient A has been exposed to the clever marketing of drugs from a very young age and believes drugs are very effective and fast acting and can give instant results against minor things such as insect bites. Patient A wakes up with a large insect bite on her arm, but is going to a wedding in two days. She will be wearing a sleeveless dress and understandably would rather not have an insect bite on her arm for the wedding.

No big deal, she knows she can get medicine that will get rid of it straight away, so she goes to the pharmacy. She asks to speak to the pharmacist. She explains she has this insect bite, what should she do? Does she need to see the doctor? Pharmacist explains, it is nothing to worry about, give it a week and it will go away. She is surprised. Should she not take something for it?

Pharmacist realises initial accurate advice is not satisfactory. Pharmacist suggests a tablet, an antihistamine, picks up a box with insect bite written on, shows the patient. Patient enquires, will this get rid of it? Pharmacist replies, yes. Patient is still unsure, what about a cream, should I not put a cream on it as well. Oh, ok a cream as well. Pharmacist picks up antihistamine cream or mild steroid cream. Patient is happier now. Patient buys tablets and cream and goes home.

Patient takes tablet, applies cream, wakes up the next day, angry and surprised to see insect bite has improved but it is still there. Two days to wedding. Makes a conscience note, that pharmacist is not very good, goes to see the doctor, explains the whole story. The doctor now has a dilemma. The doctor knows the patient does not need anything but the doctor also knows if she does not issue a prescription, the patient will be dissatisfied. So the doctor issues a prescription for a different steroid cream and a different antihistamine tablet. Patient wakes up next day, day of wedding. A little upset to see the bite, though improved is still there. It is a wedding though so she will have a fun day so she forgets about it all.

The net result is that the patient’s expectations have not been met. She is mildly dissatisfied. Her faith in her pharmacist and doctor are slightly diminished because they did not deliver what she thought was possible. The drug companies do well out of it, their marketing department can take a pat on the back, their strategy of manipulation has worked as planned.

This is all fair enough, this is how business operates in the 21st century. You sell a promise, an unrealisable expectation, you present your product as being greater than the sum of its parts, you make it impulsively desirable, you make the sale.

However, there is a major and dangerous downside to this game. It also leads to patients demanding antibiotics that are not needed and this leads to antibiotic resistance. Which has the potential to lead to future bacterial infection pandemics because all our antibiotics have become ineffective due to over use.

Now the drug companies will say correctly that they do not advertise or market antibiotics.

But, they do market and advertise drugs, and they market them as being fast-acting and very effective. This is then how the public perceives drugs to be, all drugs not just the specific ones being advertised. The public also associates antibiotics with treating infections, they don’t see much different between bacterial and viral infections. Infections are infections and antibiotics treat them. Antibiotics are drugs and drugs are fast-acting, very effective and give instantaneous results. I have a viral infection, I want to get rid of it today, I am going to go see my doctor and get some antibiotics and she better give me some.

If we are serious about tackling antibiotic resistance, we need to ban the advertising and marketing of drugs and medicines. It won’t be painless, but ignoring antibiotic resistance is playing with fire.

A recent UK government review concluded that if we do not act soon, antibiotic resistance will kill as many as 10 million people per year by 2050.

Peter Kelly is a pharmacist based in London. He recently started a public health campaign, ‘5 Simple Steps to Healthy Living.’ He runs healthy living workshops in London Colleges with his friend and qualified personal trainer Shea Jozana, you can follow their progress on the Facebook page: The friendly pharmacist

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