All Rights Reserved © 2000 Thomas W. Day
I had the honor and pleasure this week to attend a marketing training presentation for a new, incredibly complicated medical product. The presentation was competent and informative . . . and scary.
The thing that has always amazed me about the medical industry is how dumb the customers must be. In case you're under the mistaken impression that medical "customers" are patients, get real. Nobody gives a flying flock of spotted and buttered desert turtles about patients. The end-all-be-all in medicine are doctors.
For a few moments, in the early 90's, there was a thought that HMO's and hospital administrators might slither into that driver's seat. Doctors saw that coming and grabbed those positions, too, putting themselves back in control faster than Hillary could shout "Willy, put that back in your pants and zip up!"
Since doctors are the target audience, the tenor and content of medical product advertising is what makes me nervous. You'd like to think that a device that can save or lose lives would be taken seriously, wouldn't you? If you wouldn't, I will, twice, to make up for your limitations. We'll all be disappointed. The gist of all medical product marketing is "lots of pretty colors and catchy pictures." Useful information is hidden deep (and small) inside the product packaging and is thrown away with the bloody towels and used pointy objects after surgery. The constant message aimed at these highly educated, occasionally respected physicians is "this device will not require you to do any work or know anything" about your profession.
The marketing message is full of New Age nouns turned to verbs (by tacking "ize" on the end) and verbs turned to nouns with old fashioned misuse. Spiffs and perks abound. Companies put together "care packages" of free junk for physicians and their lab underlings. They box up loads of useless gadgets and print all kinds of mindless messages on sticky notes, for the sales reps to give away, when they interrupt what ought to be a physician's busy day. The product names are catchy (or funky, depending on your perspective) acronyms that remind you of new cars or video games. There are dozens of non-technical "product training" meetings presenting information that could be understood by a grade school kid. All training meetings are held in uncompromising places like Maui, Disney World, the Bahamas, and Vail. These training vacations are somewhat scaled down for nurses, but offer "let's pretend we learned something here" CEU's so the nurses and techs won't have to suffer through real accreditation classes.
Does this kind of marketing really influence physicians and surgeons? Damn straight. The industry line is that medical product sales is a "relationship business." That means the doctors have a dependent relationship on the sales representatives for everything from babysitting services to tickets for athletic events to the fee for the afternoon golf game. Often reps are also responsible for providing a basic understanding of which organ is being operated on during a given medical procedure. The only other "profession" with this kind of relationships is Congress and the soft money lobbyists. Just like the politicians, doctors have become so comfortable with the constant bribery that it's necessary to do this stuff just to get to talk to a physician about a new drug or device. Just like Senators and Representatives, not that many of the target audience knows enough about the subject to understand the technical details.
All this has led us to a very scary place in medical development. The products, both drugs and devices, have become incredibly specific, complex, and powerful. Properly used, we can compensate for the failure of just about any physical or mental function. Improperly used, current technology can replicate most physical or mental catastrophes.
Engineers, kept isolated from customers and product users by anti-tech Marketing goofs, create more and more complex products with features to treat non-existent maladies. To justify these pointless features, the "more is better" philosophy gets thrown into an endless loop between R&D, Marketing, and the docs. Nobody understands the purpose for anything, but we keep adding more things to prove we can fill all available space.
Marketing tactics use "creative" terms and acronyms that explain absolutely nothing useful. Detailed explanations are abandoned in the drive to prove that "less words, more pictures" will catch the customers' attention. Industry uses inventive, non-physiologic scenarios to sell product features to docs who, apparently, don't know enough about physiology to question those fabrications. We blow statistical smoke up their butts until they can't tell the smog from the patients. Product planning uses logic like, "Biowhatsit has three retro-bozo-refabulators in their Bonqulator, we need five in ours to be competitive." We build in five and find a doc to run a "clincal" to prove that five of these useless things was clinically necessary.
In the real world, the overwhelming majority of all medical products are used in their "nominal" condition. Docs take a neurostimulator, a pacemaker, a mechanical heart, or a surgical tool out of the box and use it as it was preset by the factory. Docs may be untrained and operating totally in the dark, but they know better than to fool with the stuff because they don't have the slightest clue how it works. Sometimes a physician will actually resort to asking the sales rep what to do and I can't begin to describe how bad things can get when that happens. I have abandoned sports equipment in my garage that has more surgical capability than the average MBA-clone sales rep.
At the other end of the knife what do we, who may become patients, do to protect ourselves? My first advice is to be very careful what you sign if you ever find yourself in a hospital. If you assume that your physician is not much more interested in your well-being than a used car salesman, you'll be in a pretty accurate frame of mind. There is no place in life where a second opinion is more valuable. Third and fourth opinions are good, too. What we ought to do as a population of prospective patients is to get the FDA and Congress off of their butts and make them fix this system or find employment flipping burgers and bobbing for French fries.
Once we boot the lobbyists out of Washington, we ought to be working at booting the bribery out of medicine. Currently, medicine has taken the military-industrial complex's place at the federal funded corporate welfare trough. Just like the pack of vampires who sucked the country dry building useless and incompetent weapons in the 1980's, medical drug and device manufacturers drained the country of vital juices in the 90's and are still at it.
Personally, I think it's time to put some teeth in the nation's treason laws and start going after those who become rich cheating the public. After a dozen or so ex-CEO's take the needle or suck down a lung full of cyanide gas, get out of the way of industry reforms. If the execs have to pay the price for their corporate failures, change will happen, with or without doctors knowing what they're doing.