Are Physicians Easy Prey?

In an article in The Lancet 30 years ago, the late Sidney Wolfe highlighted promotional material from the medical advertising firm William Douglas McAdams, Inc. entitled, Drug Advertisements That Go Straight to the Hippocampus that claimed that the hippocampus is “the prescription-writing center of the brain” and that “all WDM Inc. communications are focused on making the hippocampus respond positively to your product.” In response, a Letter to the Editor of The Lancet expressed displeasure with the journal for lending, “unwarranted credibility” to the notion that, “as a group, physicians are so uninformed and malleable that they can be manipulated…”   

Some may recall that the William Douglas McAdams company – the medical advertising firm responsible for the “Straight to the Hippocampus” campaign – was led by Arthur Sackler, whose family is now forever linked to the opioid crisis and to the infamous marketing of OxyContin by Purdue Pharma. Years earlier, Sackler worked with Pfizer on an advertising campaign for the antibiotic Terramycin; interestingly, at that time a drug-detailing memo related to Terramycin referred to physicians as “easy prey”. 

Are physicians easy prey? 

Many physicians will recall a time when drug companies sponsored lunches that featured tables decked out with food, branded pens and other items, and promotional material for that company’s medications. It was also commonplace at the time to find advertisements in leading medical journals placed right in the midst of published articles. Twenty years ago, an article in JAMA recommended prohibiting drug makers from directly financing continuing medical education (CME), and another article that same year noted that advertisements in medical journals, “… are unreliable sources of information, since they ‘educate’ physicians to prescribe the newest, most expensive drugs (which may not be any superior to existing, less expensive alternatives).” As a result of this and similar efforts, these practices became a thing of the past. 

A very recent article in JAMA discussed the presence of advertising within clinical decision support (CDS) tools alongside information that can earn users CME credits, which is a practice that seemingly was retired years ago. This article noted that while some CDS tools operate on a subscription model, “others such as OpenEvidence use advertising revenue to offer access without charge.” An entire section of the International Committee of Medical Journal Editors (ICMJE) recommendations for medical journals focuses on advertising and notes, “Best practice prohibits selling advertisements intended to be juxtaposed with editorial content on the same product”, something that is done today in certain AI-enabled CDS tools. 

Are physicians easy prey? 

Several years ago, an article on the relationship between physicians and pharmaceutical companies noted, “Clearly, a widespread view among physicians and physicians-in-training is that their professional training somehow differentiates them from non-physicians, making them resistant to influences that might be expected to affect other humans and enabling them to appraise their patients’ interests objectively and put those interests before all other considerations.” 

I’m not so sure I share that view. Physicians and physicians-in-training should find it unacceptable when an advertisement for a drug pops up as they await an AI-generated response from a CDS tool, even when that tool is available for free… or perhaps especially when it is available for free. Remember the well-known saying, “If a product is free, you are the product.” As you know, history repeats itself, and it is repeating itself now right in front of all of us.  

Are physicians easy prey? Show them the answer is no. Don’t use CDS tools with drug ads; you have other choices.