Doc: Physician promotion not direct-to-patient
Dear Dr. Roach: In a recent column, you said that companies can pay doctors to promote a product. Can these doctors promote a product in their office when it is to just one patient? If they do, I feel that it would be crossing the line of ethical conduct.
Dear C.G.: Promoting a product to one or more patients indeed would be unethical. What I meant by promoting a product is to talk to groups of prescribers, such as physicians, physician assistants and nurse practitioners, about the risks and benefits of prescribing for a particular indication. In the best situation, the information given is helpful and unbiased, which can be a useful way to learn about new treatments. However, in the worst scenario, the information given may be biased: It may not discuss the risks completely, or may overstate the benefits compared with other treatments.
It’s also very clear that these kinds of promotions do affect prescribing behavior, and there is a significant potential for conflict of interest. You want your doctor to make the best recommendation for you based on your particular medical situation, not based on whether the physician recently heard about a new drug at a free dinner. This may be overstating the ethical dilemma somewhat, but my personal opinion is that medical professionals must be very cautious about how we get our information.
For my medical colleagues, both UpToDate (a comprehensive textbook available online) and The Medical Letter (a weekly newsletter on new drugs and devices) are excellent and unbiased sources to keep current. And no, I do not accept any payment for a product or resource that I recommend in the column.
Dear Dr. Roach: We were told that there is nothing to be done about macular degeneration of the eye. We are going for a second opinion. Do you have an answer?
Dear Anon.: There are two types of age-related macular degeneration, usually called “dry” and “wet.” Dry is more common and progresses slowly over years, and it sometimes can progress to wet AMD.
Dry is normally treated with AREDS2 vitamins and careful monitoring. The vitamins slow the progression of the macular degeneration.
Wet AMD is treated with injection of medication directly into the eye, such as bevacizumab (Avastin) in addition to the AREDS2 vitamins. The sooner treatment is begun, the better. The medication is better at preserving vision than it is at bringing it back.
Dear Dr. Roach: I’ve developed a ringing in my ears, I suspect from years of loud factory work. I consider myself to have pretty good hearing. I read about a noted entertainer who was diagnosed with tinnitus and eventually will go deaf. Does tinnitus contribute to deafness?
Dear F.L.P.: There certainly is a correlation between tinnitus and hearing loss. However, it’s not that tinnitus causes deafness: Deafness often brings about tinnitus. Almost all people with tinnitus have some kind of hearing loss, but not everyone with hearing loss has tinnitus.
People with tinnitus should get a complete exam. People with long-lasting tinnitus should have a formal audiology evaluation. While there is no cure for tinnitus, it occasionally can be a clue to developing serious medical issues, and people with hearing loss and tinnitus often see improvement of the tinnitus with hearing aid use.
I recommend the American Tinnitus Association at ata.org for information.
Email questions to ToYourGoodHealth@med.cornell.edu.