Have you ever noticed that what your doctor says about a medicine is different from what you hear in advertisements or in the news? The differences may be subtle, perhaps the choice of words, or something more dramatic. In fact, it may seem like one of the sources of information — whether the media or your doctor — must be wrong. When these differences arise, it’s natural to wonder: If one medicine is clearly best in the television ads, why is a different course of treatment being recommended by your doctor? There are several possible explanations, and sorting them out may be helpful to you in understanding what your doctor is saying and how to make better health care choices.
For years, I watched advertisements for various remedies and wondered how the claims they made could be true — after all, we’d been taught a very different version of the facts in medical school and in later training. For example, consider pain relievers for “aches and pains” such as muscle soreness or minor injuries. The nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin, naproxen and ibuprofen) and acetaminophen-containing medicines (such as Tylenol) are the main players for over-the-counter options. Here are some relevant facts about them (at least as we know them now):
Even if everyone (doctors, patients, drug advertisers, news media, the FDA and agencies that oversee drug manufacturing, promotion and truth-in-advertising) agreed on the above facts, “spin” can alter how these facts are delivered. For example, one or another of the manufacturers could truthfully make the following claims, each suggesting that one medicine is superior to its competitors (even when it isn't):
A recent analysis of research comparing chiropractic care with traditional approaches (such as exercise and medications) found no difference between the two in terms of effectiveness, and both were better than no treatment. It also demonstrated how spin can alter the message even while sticking to the facts. News articles interviewing chiropractors hailed the study as proof that nothing is more effective than spinal manipulation and that it represents a safe alternative to medications. Other news reports said the study was a disappointment to the advocates of chiropractic manipulation because it did not find that such care was better than other types of care and may cost more. Some predicted that based on this research, insurers would be more likely to cover chiropractic care for back pain; other news articles stated just the opposite.
One finding of the study that was buried in the “spin” was that neither traditional therapies nor chiropractic care were dramatically helpful compared with no treatment! With all of this shifting emphasis depending on the messenger, no wonder the message from your own doctor may differ from that you happen to read or hear in the news.
There are many other examples of this phenomenon. If you ask your doctor about allergy medicines (such as Allegra or Claritin), the newest anti-inflammatory medications (such as Celebrex), or medicines for heartburn (including Nexium or Prilosec), your doctor may suggest a different treatment. A nonprescription medication or an older, generic medicine may work as well at a fraction of the cost. Your doctor may even suggest no medication for your problem, especially if symptoms are mild and avoidable. For example, some allergy sufferers can simply avoid certain plants at particular times of the year and do well without medicines.
A common situation that I encounter in the office is the request for a medication that a friend or family member is taking. It’s a logical question — there seem to be no side effects and it’s working well for them, so why not try it? If your doctor is not enthusiastic about the idea, it may be because your symptoms or illness is quite different from that of your friend, or your other medical problems and medications may make that treatment less attractive. In that situation, what your doctor is saying is this: Each person is different so the risks and benefits of treatment will differ.
Although the ideal situation might be objective, scientific analysis driving every medical decision, the fact is that there is much we don’t know, we all have our biases and are affected by the bias of others. The undeniable truth is that “reversing spin” is an enormous challenge. Consider the following reasons that operate to manipulate the health care message:
When it comes to health care decisions, the facts are important but so is spin. Simply recognizing that spin is at work is not easy. Perhaps the best any of us can do is to stay informed, relying as much as possible on impartial information from sources that are not trying to sell us something. Read medical writers who seem to look at stories from more than one side. But recognize that everyone is biased to some degree and everyone has a perspective that influences his or her outlook. Recognize that there may be a number of good explanations (and some that aren't so good) for why the message of news media and advertisements differs so much from what your doctor is saying. My advice is this: Be skeptical about what you read or hear and, importantly, consider the source.
Establish a relationship with a doctor you trust and ask questions about something you’ve heard or read, especially if you are unsure about the reliability of the source. Ask why your prescription is being changed. Perhaps you would elect to pay a higher price out of pocket to stay on it, or perhaps you’re willing to switch because your insurance company wants you to, but either way, you’ll be better informed if you ask about it. Academic medical centers and government agencies are often good sources of information because they do not have “vested interests” likely to alter the medical message — but that may just be my bias.
Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.