I recently received a call from a friend of mine in Shri Lanka who mentioned that he was looking into how marketing was being used by the big drug companies. In fact marketing in medicine and by pharmaceutical companies is massive both in the UK and USA as well.

Dr Wijesinha writes that he had the very pleasant experience recently of meeting some of his old friends who graduated from medical school about the same time as him.

“Notwithstanding the fact that it is now several decades since we graduated as doctors, we were able to turn back the years and reminisce about those days in the last century when we took our first hesitant steps into the world of medicine – and how much in medicine has changed since then.

Although medical technology has advanced tremendously since those days and methods of diagnosis as well as therapy have changed (in some instances quite drastically) we realized that not much has really changed when it comes to getting patients to comply with the advice that we with the best intentions give them.

When a patient comes to consult us with a medical problem, it is usually not difficult to diagnose what is wrong and decide on appropriate treatment. Even as a general practitioner or OPD doctor working in a small clinic, you don’t need CT scanners and $500 blood tests to make these decisions. What is difficult however is convincing the patient to follow your advice. As one of my friends observed, “Horses will come to the water trough, and even pay you a handsome fee for the privilege of coming to your water trough – but that does not mean they will drink the water you offer them!”

This brought us on to the topic of whose responsibility it is to ensure that a patient complies with the medical advice that a competent, well trained and well-intentioned medical practitioner gives him. Can – or should – a doctor spend time and effort trying to care for a patient who doesn’t care about himself? As a classic example, I have a patient who does not smoke, drinks minimal alcohol, exercises reasonably regularly and is not overweight. Unfortunately he has very high blood pressure – but he does not under any circumstances like to take long term tablets. I have measured his blood pressure on several occasions in my consulting room, showed him the reading on the meter (rarely less than 190/100, which is grossly above what it should be) and tried to convince him using all the persuasive powers at my disposal that he has a very high risk of suffering a premature heart attack just as his father and his older brother did, unless he accepts the fact that he needs to take tablets on a regular and long term basis to get his blood pressure down.

Every time I try to sell him the idea that he should take tablets, he responds, “But I feel fine, doctor – I don’t feel unwell at all! I don’t need tablets”

When I was younger, I would look on my inability to convince him to start medication as a failure on my part – but as I have got older, I have come to accept that although my agenda as a good doctor is to find out what is the matter with the patient and try to correct this, my agenda is in conflict with what matters to the patient – which is to feel that he is not an invalid who needs to take tablets.

Unless he is convinced that his taking tablets to lower his blood pressure will be beneficial to him, unless he buys into what I have been trying so hard to tell him, unless he accepts my advice and makes it his own, he will not comply with my well-intentioned advice – and will continue to be at serious risk of following his family history of a premature and fatal heart attack that could have been prevented.

I strongly believe that our medical schools in Sri Lanka have been teaching our students good Medicine over the years.

Maybe they should also have taught us how to market this medicine to obstinate consumers.

What are your thoughts? Do you think that marketing medicine to patients is a skill that GPs lack? Or should you as a patient listen to the doctor and finish your whole course of tablets, because (s)he told you to?

Over the next week we will look at the marketing undertaken by the big drug companies for neurofen, anadin etc and see exactly how they do it.