The world changed when Bob Dole shared his tale of erectile dysfunction over prime time television. Now, not only is ED known to millions, but whenever you mention “getting into the game,” everyone snickers. From little purple pills to ads suggesting that your shyness might be curable, direct-to-consumer advertising has become a huge part of pharmaceutical marketing. For the most part, in my mind, such efforts have had a positive effect—and not just on drug manufacturers’ bottom lines.
Discussing potentially stigmatizing issues such as impotence (oops, I meant ED) or depression have become much more socially acceptable. With politicians and celebrities openly discussing their most intimate problems, many more patients come to my office requesting help. And such dialogue has certainly raised awareness about important medical problems that have been relegated to embarrassed locker room conversations.
Of course, there are problems. We have all had patients self-diagnose incorrectly, demand unwarranted treatments, or request an expensive medication when an inexpensive, equally effective alternative exists. And for a condition to garner any attention, a patented product must be available to promote. For years I have lectured on sleep disorders, promoting the use of dopaminergic agents such as levodopa/carbidopa for restless legs syndrome. But only recently, with the approval of a new generation of expensive medications, have pharmaceutical firms begun educating the public.
In fact, I often wonder if conditions are made up to promote products. Take social anxiety disorder (SAD). Sure, there are people who can benefit from treatment, but I wonder if the vast majority of such patients are simply shy, reserved, or reticent. Now we have screening tools for SAD, patient education materials, and a raft of ads directed to promoting diagnosis and treatment. The downside of treatment and the potentially stigmatizing effect of labeling a trait as a problem are seldom considered. Likewise, fatigue is a treatable condition requiring expensive new medication; everyone with a bit of heartburn rushes for a pill. I really wish companies would refrain from touting a specific pill or treatment, and confine their message to, “If you think you have this problem, ask your doctor. Effective treatment is available.”
Nonetheless, I wouldn’t trade today’s situation with the “good ole days.” I am happy that patients actually can talk about sexual dysfunction or depression, and know they are in the company of the stars.