Point & Commentary

Physicians Back in the Driver’s Seat

By James M. La Rossa Jr.

At the beginning of 1997, the seasoned CBS newsman, Mike Wallace, and his wife Mary, sat for a portrait cover of the first Mental Fitness Consumer edition.1 Wallace’s honest disclosure about his suicidal depression was as brave as it was helpful to men who equated depression with weakness.

MedWorks printed 120,000 of that issue and sent it to physicians as a “Waiting Room Copy”—a new concept in ‘97. Since that issue, other companies have attempted to use the waiting room as a distribution point. These programs, by and large failed, since doctors were wary of cluttering their waiting rooms with single-sponsored literature. Nevertheless, an independent publication trying to assert third-party credibility like MentalFitness, hit a resonate chord with some of the 120,000 readers of that first 1997 issue, according to data collected from this publication.2

One of the most important new trends in medicine also took off in 1997: pharmaceutical advertising on television. Once the FDA approved direct-to-consumer spending by drug companies, the investment rounded more than $1 billion3 in a heartbeat.
According to reliable data, ad spending by drug companies continues to grow. Ad expenditures soared 21% last year to $3.43 billion. Madison Avenue-caliber advertising for antidepressants, sleep aides, migraine relief drugs, erectile dysfunction cures, and the like, were as publically visible as agents in other pre-existing therapeutic categories, such as seasonal allergies and athlete’s foot.

The race was on. As agents matured, consumers were hit with a barrage of product-specific ads for illnesses like social phobia, posttraumatic stress disorder, attention deficit disorder, and drugs to ease monthly pain caused by menstruation. The amount of prescriptions written by doctors rose dramatically. Whether the commercials spawned more choices for prescribers, or better diagnosis of psychiatric maladies, is under debate still.

Following 1997, the DTC wave began to crest. Published reports indicate that drug companies continue to try to reach the patient. But with “groundbreaking” new agents reaching maturity (and some losing patent rights), it is up to the physician—more than ever—to make a choice for the patient based on her/his clinical experience. If the patient asks for “Prozac,” the doctor interprets that the patient wants a “Prozac-Class” agent. The doctor may have had better experience with another, somewhat similar drug, such as Paxil, Zoloft, or Effexor. The same market forces are evident in the antipsychotic class of drugs—where choices abound—as well as ADHD agents—which have sprung-up one after another after another. That puts the doctor back in the driver’s seat. This is one of two forces which make the need for MentalFitness (A Doctor-Directed Publication) so important.
“While ads that compare the stain-fighting power between laundry detergents are common, prescription drug makers have typically refrained from making superior claims in ads,” according to The Wall Street Journal in a story outlining the bold head-to-head claims between two migraine drugs.3

Treating patients through shared information

MentalFitness is the first “Doctor-Directed-Publication” (DDP) in psychiatry, brought to you by the largest supplier of psychiatric journals in the U.S. The journal is not a dumbed-down version of a professional medical journal, but is its own unique entity designed to engage physicians so much so that they will want to use MentalFitness DDP to screen, explain, and relax the newly diagnosed patient. MentalFitness DDP will be a great asset to psychiatric nurses—who are called-on to diagnose and identify mental maladies in patients with greater frequency. One of MentalFitnesses’ goals is to treat patients through shared information. Each issue will have pull-out assessment guides to assist the doctor or nurse to screen the patient. These very guides—
along with articles and stories in MentalFitness—can de-mystify mental illness, which is the first step in having a cooperative, compliant patient. (You will find three such educational resource guides bound into the center of this journal.)
On a humanistic level, it can be said that of all the passages one goes through in a lifetime to attain happiness, the mind is the gatepost of all measure. What can we do to foster personal growth and moral grounding? Or to have deeper and more significant relationships? How can we be more attuned to our friends and coworkers? And will we attain happiness by accomplishing these things?

There is a great need for a DDP publication such as MentalFitness. Last month I took my son to his psychiatrist. While I waited for him, I picked-up literature placed on a table in the waiting room. Every single brochure was produced by a pharmaceutical company. They were all very well done. But there was a “boilerplate” quality to all of them. If I had a magazine like MentalFitness to read while I waited, my time would have been better spent. At the very least, my son and I would have had more to speak about on the ride home.

1. MentalFitness. Autumn, 1997
2. Internal MedWorks Data; 1997/1998. An analysis of 3,500 readers
3. The Wall Street Journal. Monday, April 5, 2004.