Law in the Internet Society

The Doctor, the Pill, the Website

It seems fairly obvious that doctors, who are relied upon to choose the best course of treatment for their patients, and pharmaceutical representatives, who simply intend to sell their products, should eat lunch separately. But for years, doctors and pharmaceutical representatives have been sitting together, typically with doctors eating from drug reps.’ hands. We may imagine that doctors were less troubled than patients were by this relationship; many doctors may have acknowledged that although they were being lobbied, that fact would not result in different, inferior treatments for their patients. This may have been true since they were their patient’s primary source for medical information and thus, they still retained the discretion to decide whether to prescribe the drugs that were being pushed on them. But now, due to the growth of the online healthcare market, the former is no longer the case, and as a result, neither is the latter. Websites, not doctors, are increasingly becoming the primary sources of medical information for healthcare seekers. And as potential patients come to “their own” conclusions about what treatment they need and desire, doctors’ ability to exercise their discretion to decide what treatment patients ought to undergo is consequently disappearing. True doctors, concerned with choosing the best course of treatment for their patients, have all but lost their seat at the table.

Pharmaceutical Capture of the Online Healthcare Market

Pharmaceutical capture of the healthcare industry has been a pervasive problem, with wealthy drug companies controlling lawmakers, advertising opportunities, and despite some restrictions and standards, doctors’ attention. In theory, the growth of the online healthcare market—the increasing presence of online medical information sites and self-diagnosis tools—could have threatened drug companies’ stranglehold on medical information. That is because low-cost, doctor-developed healthcare websites could have given doctors an avenue through which to share their unbiased medical knowledge with patients: a potentiality which would have essentially lowered patients’ costs of interacting with doctors and would likely have strengthened doctor-patient relationships in general. But this has not been the case. Instead of doctor-developed healthcare websites, the online healthcare market has evolved as a place where a few, highly-trafficked sites are maintained on behalf of pharmaceutical companies in order to dominate patients’ attention.

The most popular of these websites for instance, WebMD? , previously headed by a former Pfizer chief executive, and now run by a former Merck & Co. executive director, is admittedly connected to pharmaceutical advertising. WebMD? and similar sites offer advisory articles and easy-to-use diagnostic tools that unsurprisingly, tend to recommend the use of certain drugs. These websites will not always advertise the drug outright, and will less frequently note that the advice is coming from the drug manufacturer, but they will promote their sponsor’s product. By means of analogy, if banners and pop-up ads are the equivalent of drug commercials on TV, then WebMD? and websites like it are something like Dr. Oz: a source many patients will look to for information, perhaps being guided by an underlying desire for entertainment, or just an easy answer, while often not realizing they are in the middle of a product pitch.

The Minimized Role of Doctors

The growth of the online healthcare market has led to a minimized role for doctors. For patients, obtaining information from a doctor is costly and time-consuming whereas obtaining information from a website is free and instantaneous. With healthcare websites offering free, quick, and compelling diagnoses derived from a seemingly encyclopedic information database, it is unsurprising that healthcare seekers are increasingly finding online self-treatment preferential to and more trustworthy than a doctor’s treatment. While it is true that the actual administration of many treatments, pill prescription or surgery for example, can only be performed by a doctor, given the necessity of a patient’s complicity in undergoing a treatment and patients’ ability to shop for doctors, doctors’ roles have increasingly shrunk. That is, because doctors diagnostic abilities are now trusted less by their patients, because they cannot typically force their patients to accept a course of treatment they prescribe, and because patients retain the ability to find a doctor that will give them a desired course of treatment, doctors have lost nearly all of the bargaining power they previously retained in their patient relationships. Less and less do doctors maintain discretionary authority to prescribe a course of treatment; their role has been minimized and consists now, mostly of treatment administration—pill pushing and physical manipulations.

A Warning to Other Professions?

As much as the troubles of one profession can serve as a warning to other professions, the minimized role of doctors as a result of pharmaceutical capture of the online healthcare market should serve as a warning to other professions, lawyers included. When the balance of power in a professional relationship relies on the client’s deference to professional discretion, the professional’s power can be displaced by any other factor which attracts the client’s deference. Online interfaces are generally, increasingly capturing the attention of potential clients of all sorts. When the online interfaces that receive the most attention are themselves captured by groups with interests adverse to the professionals working in the same field, like in the case of the online healthcare market, balances of power will be shifted.


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r5 - 07 Jan 2015 - 03:27:57 - NigelMustapha
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