Wednesday, March 26, 2008

The Jarvik affair

In July 2007 the blog "Ask Your Doctor" was published on MedTruth, a commentary on truth in medicine, describing direct-to-the-consumer pharmaceutical ads, in which a frequently well known pitchman (or pitchwoman) "beams" the benefits of the advertised pharmaceutical to a national audience, in a quest to snag as many of them as possible on the drug. The companies justify these ads by saying they are performing a service--giving information to the viewing public that may be of great benefit to their health. But, if you and the viewing audience do as told, i.e., "ask your doctor"--and many of them do--you might find yourself taking an expensive and unnecessary medication, incurring the risks of serious side effects or corrupting your relationship with your doctor who may be actually quite reluctant to put you on any more medications.

However, other than the foregoing, there are many mistruths to these ads. The pharmaceutical advertised may not actually be as effective as portrayed. It may be more hazardous. The celebrity pitchperson, who usually says he or she is also a patient taking the drug--"and the reason I'm taking it is because I know the difference--you wouldn't think a person like me would take a dud--or recommend one to you--do you?" Even the background of the ads--country clubs, dances, social environments that only people in good health--and experiencing high-quality times--can partake of. But these ads can also deceive. Despite the celebrity spokesperson being a well known--even respected--individual, all of what may be said or inferred to the viewing or listening audience may be untrue.

Just how much this deceit may be involved in these kind of ads was recently brought home by the televised and print ad campaign of Dr. Robert Jarvik.

Dr. Jarvik, highly respected pioneer in medicine, was the inventor of the first working artificial heart to be used in human patients. In March 2006--as described in the February 8, 2008 and February 27, 2008 New York Times--he began serving as the celebrity spokesperson for an ad campaign by the pharmaceutical company Pfizer, in behalf of its top-selling, cholesterol-lowering drug, Lipitor.

Now you would think Dr. Jarvik knows a lot about heart and cholesterol-lowering medications and would not lend his name to anything that is not absolutely true.

During the first three months of the televised ad campaign--from March 2006 through June 2006--the ad depicts Dr. Jarvik rowing a racing shell--sculling--across Lake Crescent, near Port Angeles, Washington. In this ad Dr. Jarvik looks in his early 60s (he is actually 61) and the viewer has got to think: "He's in pretty good shape to be sculling in a big boat like that by himself at his age," and secondarily, "he knows what he's doing taking Lipitor." During the ad campaign Dr. Jarvik says: "I take Lipitor."

But it turns out Dr. Jarvik was not sculling at all. It was a stand-in double. Seattle rowing enthusiast Dennis Williams. (His role as stunt-double for Dr. Jarvik was described in a newsletter published by the Lake Washington Rowing Club, of which he is a member.) Williams was used to confuse the television audience into thinking it was Dr. Jarvik whose apparent excellent physical health was somehow linked with his good judgment in taking Lipitor.

But turns out also that during the first part of the ad campaign--at least during the first month--Dr. Jarvik wasn't even taking Lipitor. That when he was initially reciting the drug's benefits, he wasn't the recipient of them. Then what would propel him to be this drug's spokesman?

$1,350,000. That's what Pfizer said it agreed to pay Dr. Jarvik as a minimum over two years for serving as celebrity spokesperson for Lipitor. Pfizer then revealed it has spent more than $258 million advertising Lipitor, most of it on the Jarvik ad campaign!

During his ad campaign Dr. Jarvik additionally enthuses over Lipitor "as a doctor and a dad." This statement is true, however, only in the most general sense. While he is actually an M.D.--and actually a "dad"--he did not go through residency training and is not licensed to practice medicine or prescribe drugs. The inference ("as a doctor") that it is as a clinically experienced physician that he is recommending Lipitor is thus open to question.

All advertising campaigns have a "director"--usually an advertising agency or public relations firm. But in the case of Lipitor, Pfizer did not hire one--but nine--high-powered advertising agencies or PR firms to make sure you, the public, do not escape Dr. Jarvik's message. The average John Q. Public of a national television audience is no match for nine advertising agencies, who have on their staffs some of the keenest psychologists, sociologists and swayers of public and personal opinion in the nation. In hiring these firms Pfizer is doing everything it can to compel you to act quickly and positively on its message.

While we do understand that national spokespersons for ad campaigns such as for Lipitor are paid money for their services, we are loath to accept that a person such as Dr. Jarvik would use his considerable celebrity status simply to make money--and not necessarily believe the message he was disseminating to the public.

If Dr. Jarvik had begun his campaign by stating, "The reason I'm saying this is that Pfizer gave me a lot of money to do so, not that I believe it--heck, I'm not even taking it!" would you believe his pitch? Would you rush out to get the drug? Would you besiege your doctor for it? If you knew Dr. Jarvik was the centerpiece of what would shortly become a quarter of a billion dollar ad campaign designed to make Pfizer a fortune, would that erode your confidence in Dr. Jarvik's message?

If you knew it was not Dr. Jarvik sculling across Lake Crescent in that racing shell, but someone else made up to look like him, made up to look like someone in peak physical condition, would you think that good physical health was associated with Lipitor? If you knew that Dr. Jarvik knew that it wasn't he sculling across Lake Crescent--but let the public think otherwise--would you pay heed to Dr. Jarvik's message?

If you knew that Dr. Jarvik let you believe he was on Lipitor while reciting its benefits--but actually was not--would the integrity of his message be altered for you?

If you knew that although Dr. Jarvik holds a medical degree he is primarily an inventor, not a clinician--who is not licensed to practice medicine or prescribe drugs, who did not undergo clinical residency training--would you have confidence in his recitation of the clinical benefits of Lipitor?

If you knew that nine experienced ad agencies or PR firms were conspiring against you in order to tip the balance of your thinking in favor of Dr. Jarvik's message, would you be more inclined to follow its advice?

These questions reveal that the entire wording and visual depictions of this ad--as in many direct-to-the-consumer pharmaceutical ads--is composed of untruths. In this ad Dr. Jarvik is not sharing his knowledge of a drug with you out of the goodness of his heart or because it may be helpful to you--but because he is being paid to do so. Substantially so. Dr. Jarvik is not rowing a boat across a lake--and he knows he isn't--but is allowing you to think he is in order to program your mind that taking Lipitor is in some way associated with excellent physical health. Dr. Jarvik's setting for Lipitor's clinical benefits is by personal example--even though he is not taking it. Dr. Jarvik allows you to think his recommendations for Lipitor is based on his clinical experience ("as a doctor"), even though he has not undergone formal clinical training nor does he practice medicine or prescribe drugs.

The Jarvik ad campaign illustrates the many untruths inherent in pharmaceutical ads. The New York Times cautions that these ads must be taken with a "very large grain of skepticism." But it is more than that. For these ads, utilizing celebrity personages as their central focus, are structured in deceit and function to spread misinformation over a largely medically uninformed public. For me the totally demoralizing aspect of this particular ad campaign is that Dr. Jarvik, who is genuinely a medical innovator, should choose to use his well deserved celebrity as the centerpiece of a web of untrue words and images--merely for the sake of money.