Pfizer pulls Jarvik Ad; Antibiotics Overused in Dementia

There are two stories that just hit the media cycle. Both are relative small news but have much broader implications.

Pfizer pulls Jarvik TV Ad
It was only a matter of time. Criticism started to mount back in March with Pfizer's use of Dr. Robert Jarvik, inventor of the artificial heart, to promote their #1 selling drug Lipitor. The issue at hand was that the advertisement implied that Dr. Jarvik was a medical doctor that prescribed Lipitor for his patients. Though Dr. Jarvik did get an MD, he is primarily an inventor and researcher and does not practice clinically. In January, congress looked into this potential misrepresentation. Though Pfizer initially stood by Dr. Jarvik and the ad, continuing criticism forced them to pull the ad today.

The bigger issue here is not the use of celebrity endorsements to sell pharmaceuticals or even whether or not Pfizer should of been more clear about the fact that Dr. Jarvik can not legally write a prescription. Though promotion of pharmaceuticals on television is already a complicated issue, the use of a physician pitchman makes this more complicated. The public is likely very aware that when Sally Field promotes Boniva for osteoporosis, she is a paid celebrity endorser of the product. However, physicians have an primary obligation to their patient's best interest, which is compromised by a paid endorsement (Jarvik made $1.35 million). Though Dr. Jarvik does not treat patients, by promoting a product to the public who migh use this product, he is making a medical recommendation. As medicine and the media continue to mix, industry and consumers must be very careful about this ethical line. What about celebrity physicians that are real MD's? Would it have been better or worse if cardiologist Dr. Steven Nissen (who himself is becoming a media celebrity) had been in the ad instead of Dr. Jarvik?

Antibiotics overused in dementia patients
Several sources are reporting on a study in the Archives of Internal Medicine regarding the overuse of antibiotics in the nursing home setting. This study looked at 214 nursing home patients with advanced dementia for a year and a half and found that two-thirds were treated with antibiotics. More importantly, the closer the patients came to death, the more antibiotics were used.

Much of the discussion regarding these findings is focusing on the concern about overusing antibiotics leading to the development of infectious agents that are resistant to the antibiotics we commonly use. This is indeed important, but the bigger issue is here regards over-treatment in general. The politicians can debate the merits of mandates or whether tax incentives should be used to help pay for health care. However, the biggest driver of cost is use of medical services such as prescriptions, diagnostic tests and procedures. Everyone wants the best possible medical care, but we simply can not afford this for everyone. We spend a substantial portion of our country's health care dollar on the first and last days of life. Advanced stage dementia is a terminal illness. As one physician commented, “If we substituted ’end-stage cancer’ for ’advanced dementia,’ I don’t think people would have any problem understanding this.” It's one thing for a family to choose not to insert a feeding tube to their loved one dying of cancer. It's quite another not to give grandma some antibiotics when she has a fever. (Antibiotics in advanced dementia do not prolong life, may not improve suffering, and are likely harmful by increasing resistant organisms). If we are going to solve our health care crisis, we are going to have to discuss what we are willing to pay for, and what may not be worthwhile. Our "please do everything you can doctor," society may not be ready to handle this.