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Selling out
THE LANCET
THE LANCET Volume 350, Number 9077 EDITORIAL
Selling out The evolution of American medicine is a curious business, in all senses of these words. Doctors have become generic “health-care providers” employed by large and profit-oriented corporations. Meanwhile, patients have been transformed into “health-care consumers” who seem to represent nothing more than “market share” in the corporate suite. There was a time when patients could look to the American Medical Association (“physicians dedicated to the health of America”) to help redress the moral imbalances in American health. But last week, the AMA sold its name, and in doing so forfeited part of it’s power to do the right thing. The AMA has agreed with the US appliance manufacturer Sunbeam to make money endorsing Sunbeam’s line of home health-care products. The association refuses to say how much, only that its own margin in the deal will be tied to royalties from product sales. In the 5-year exclusive contract, the AMA will endorse Sunbeam heating pads, bloodpressure monitors, thermometers, air cleaners, scales, and other home health products. (Massagers will also be covered since, as the joint AMA/Sunbeam product fact sheet carefully points out, Sunbeam is “the first to introduce a foot bath with both massage and pedicure features”.) In addition, the AMA will supply educational materials for product packaging, sponsor events such as public blood-pressure screenings, and create a physicians’ advisory panel to help Sunbeam bring new home health products to market. One of the more worrisome features of the agreement is its exclusivity. Will competing equipment, equally good (or better) but less expensive and not bearing the AMA logo, be shunned by patients? Are doctors now obligated, given the reputation of the AMA, to recommend only AMA-approved humidifiers? In a litigious society, might they be under pressure to do so? Should patients believe their doctors or hospitals are less competent because they recommend a brand other than the one that profits the AMA? In what position would the AMA find itself should one of these products prove defective or dangerous? And Vol 350 • August 23, 1997
will the AMA be barred from recommending a safe substitute to the public? Product endorsements are not new in American medicine. In the late 1950s, the American Dental Association gave its seal of approval to Crest toothpaste, and within a short time Crest’s market share rose to nearly 30%. It became the best selling toothpaste in America. However, unlike the AMA, the ADA did not make a commercial venture of it and soon many brands meeting ADA quality standards began to carry its seal. More recently, the American Heart Association’s food certification programme has given its seal to nearly 580 foods made by 53 different companies. Both ADA and AHA charge these companies only for product testing and, unlike the AMA arrangements, neither makes money on royalties from sales of the products it endorses. And in the UK, a row blew up last week about the British Medical Association’s aggressive sales tactics. In the magazine GP, a story alleged that the BMA was selling personal details of its 155 000 members to any business prepared to pay 13p per record. Information about doctors is being sold according to their “geo-demographic profile”. This profound commercialisation of what had been seen as a professional organisation for physicians has caused dismay and shame amongst many British general practitioners. Is the AMA’s manoeuvre likely to produce a similar visceral expression of disgust amongst it’s members? One reaction was predictable. “This is a coup for Sunbeam”, Sam Craig, professor of marketing at the New York University Stern School of Business told The Lancet. “It infuses new life into their product line. I can’t see any downside for them”. Neither could Wall Street. In a week that saw the Dow Jones share index tumble, Sunbeam’s stock soared to a new high. A coup indeed. But for doctors, patients, and health officials who look for integrity and impartial medical advice from the AMA, it was little more than a betrayal.
The Lancet 529
THE LANCET Volume 350, Number 9077 EDITORIAL
Selling out The evolution of American medicine is a curious business, in all senses of these words. Doctors have become generic “health-care providers” employed by large and profit-oriented corporations. Meanwhile, patients have been transformed into “health-care consumers” who seem to represent nothing more than “market share” in the corporate suite. There was a time when patients could look to the American Medical Association (“physicians dedicated to the health of America”) to help redress the moral imbalances in American health. But last week, the AMA sold its name, and in doing so forfeited part of it’s power to do the right thing. The AMA has agreed with the US appliance manufacturer Sunbeam to make money endorsing Sunbeam’s line of home health-care products. The association refuses to say how much, only that its own margin in the deal will be tied to royalties from product sales. In the 5-year exclusive contract, the AMA will endorse Sunbeam heating pads, bloodpressure monitors, thermometers, air cleaners, scales, and other home health products. (Massagers will also be covered since, as the joint AMA/Sunbeam product fact sheet carefully points out, Sunbeam is “the first to introduce a foot bath with both massage and pedicure features”.) In addition, the AMA will supply educational materials for product packaging, sponsor events such as public blood-pressure screenings, and create a physicians’ advisory panel to help Sunbeam bring new home health products to market. One of the more worrisome features of the agreement is its exclusivity. Will competing equipment, equally good (or better) but less expensive and not bearing the AMA logo, be shunned by patients? Are doctors now obligated, given the reputation of the AMA, to recommend only AMA-approved humidifiers? In a litigious society, might they be under pressure to do so? Should patients believe their doctors or hospitals are less competent because they recommend a brand other than the one that profits the AMA? In what position would the AMA find itself should one of these products prove defective or dangerous? And Vol 350 • August 23, 1997
will the AMA be barred from recommending a safe substitute to the public? Product endorsements are not new in American medicine. In the late 1950s, the American Dental Association gave its seal of approval to Crest toothpaste, and within a short time Crest’s market share rose to nearly 30%. It became the best selling toothpaste in America. However, unlike the AMA, the ADA did not make a commercial venture of it and soon many brands meeting ADA quality standards began to carry its seal. More recently, the American Heart Association’s food certification programme has given its seal to nearly 580 foods made by 53 different companies. Both ADA and AHA charge these companies only for product testing and, unlike the AMA arrangements, neither makes money on royalties from sales of the products it endorses. And in the UK, a row blew up last week about the British Medical Association’s aggressive sales tactics. In the magazine GP, a story alleged that the BMA was selling personal details of its 155 000 members to any business prepared to pay 13p per record. Information about doctors is being sold according to their “geo-demographic profile”. This profound commercialisation of what had been seen as a professional organisation for physicians has caused dismay and shame amongst many British general practitioners. Is the AMA’s manoeuvre likely to produce a similar visceral expression of disgust amongst it’s members? One reaction was predictable. “This is a coup for Sunbeam”, Sam Craig, professor of marketing at the New York University Stern School of Business told The Lancet. “It infuses new life into their product line. I can’t see any downside for them”. Neither could Wall Street. In a week that saw the Dow Jones share index tumble, Sunbeam’s stock soared to a new high. A coup indeed. But for doctors, patients, and health officials who look for integrity and impartial medical advice from the AMA, it was little more than a betrayal.
The Lancet 529