July 8th, 2003

Tube Feeding

By Vincent P. Bzdek
Washington Post

"Cholesterol, Issues and Answers," Scene 1: Fade in on a Recovering
Heart Patient, sixtyish and slightly disheveled, as he talks frankly about all
he did wrong before his bypass. Ate wrong. Drank wrong. Didn’t exercise. Never
paid attention to his triglycerides or cholesterol, good or bad.

Contritely, he tells the camera: "If I have to take a pill once a day
to keep my cholesterol down, I can live with that."

Cut to Program Host, an authoritative yet kindly Anthony Edwards figure. Exuding
reassurance, he lists the many benefits of lowering your cholesterol with diet,
exercise and medicine.

Dissolve to Vibrant, Smiling Woman in Her Seventies, another recovered heart
patient, who is planting flowers in a leafy suburban back yard. In voiceover,
she describes how the prescription drug Plavix has helped prevent her heart
problems from recurring.

"Taking Plavix once a day helps protect me," she says.

Two Cute Grandchildren run up for a hug, and she squirts them playfully with
the garden hose. Shrieks, smiles, dappled sunshine. And fade.

Following "Cholesterol" in tonight’s program lineup:

• "Asthma: One Breath at a Time,"

• "Rhythms of the Heart: Advances in Arrhythmias," and then
that noir classic,

• "Irritable Bowel Syndrome: Breaking the Secrecy Barrier."

Introducing the Patient Channel, coming soon to a hospital near you—unless
activists worried about the marketing of drugs to bedridden patients succeed
in pulling its plug.

The year-old broadcasting venture by General Electric features a 24-hour slate
of half-hour education programs on such topics as cancer, diabetes and heart
disease—punctuated by advertisements for prescription drugs and other medical
services. GE says the idea behind the enterprise is to give hospital patients
timely treatment information presented with just a dash of Hollywood razzle-dazzle.

"The one place in the world you couldn’t get good health information was
in the hospital," said Bruce Dan, a Bethesda internist who is managing
editor of the Patient Channel. "Now there are smarter patients and better

However, the 800 hospitals that carry the network—including Walter Reed
Army Medical Center in the District and Inova Fair Oaks in Fairfax—don’t
pay for the broadcasts, which are transmitted via satellite and shown on hospital-owned
TVs in patient rooms and waiting rooms. All Patient Channel costs are paid by
pharmaceutical and medical services companies that advertise on the network.
The Patient Channel, they say, is the logical next step in their push to market
directly to consumers.

But the move has triggered a backlash among some hospitals, doctors and consumer
advocates, who say a hospital is no place to be selling drugs. The fight is
one of the newest flashpoints of a larger battle over the limits of commercial
and corporate access to once-protected public and private spheres.

"The Patient Channel turns a hospital into a huckster for drugs when it
should be a place people go to heal," says Gary Ruskin, co-founder of Commercial
Alert, a Ralph Nader-led nonprofit group leading the attack. "It’s gulling
the sick in their hospital beds."

Others argue that ads aimed at a hospital’s captive audience help drive up
drug costs because patients insist on more expensive medications that may not
be much more effective than less-advertised drugs. A recent study by researchers
at Harvard University and the Massachusetts Institute of Technology found that
direct-to-consumer marketing was responsible for 12 percent of the increase
in prescription drug sales, or an additional $2.6 billion, in 2000.

"This is an extreme example of where we’re going in the confusion of commerce,
health and education," says Marcia Angell, senior lecturer for the Department
of Social Medicine at Harvard Medical School and former editor of the New England
Journal of Medicine. "Twenty years ago it was just called health care.
Now it’s the health care ‘industry.’ I’m not sure that’s a good development."

Medium vs. Message

But is the Patient Channel really such a departure?

After all, a one-hour stretch of programming contains only two to three minutes
of recognizable product advertising, far less than the amount shown on regular
TV networks, said Patrick Jarvis, spokesman for the Patient Channel.

All the ads, he said, have been approved by the Food and Drug Administration.
And it’s not as if the sell is harder. Notes Dan, "When you’re in the hospital,
you see the same exact ads on other channels."

What then is all the fuss about? The problem, say opponents, is the confusion
created for vulnerable patients when the ads are presented in a hospital context.

"When you’re a hospital, you’re taken as the health care source for patients
. . . or even in the community," said Mary Ann Ninnis, spokeswoman for
Universal Health Services (UHS), one of three major hospital chains that decided
in April against subscribing to the Patient Channel. (UHS oversees 100 hospitals.
Catholic Healthcare East and Catholic Healthcare West, which also turned down
the Patient Channel, operate 94 and 42 hospitals, respectively.)

Patients, said Ninnis, could see the services advertised on the Patient Channel
"as something they are supposed to do versus having choice. That’s why
it is basically our policy not to permit outside sources to provide information
that could influence a patient’s thinking. You have to be very careful . . .
and not even give a whisper of a preference. They need to make their decision
on their own."

Commercial Alert, founded five years ago to oppose "the excesses of commercialism,
advertising and marketing," mailed letters in February to the CEOs of 60
U.S. hospital chains, urging them to stop GE from reaching its goal of installing
the Patient Channel in 1,100 hospitals this year.

But since the Commercial Alert challenge, the number of hospitals signing up
for the network has spiked, said Dan, a former senior editor of the Journal
of the American Medical Association and former medical editor of ABC News.

"We’ve had some hospitals call us back and say, ‘We can’t stand Ralph
Nader. We’d like to sign up,’ " he said.

Bill Swisher, spokesman for Walter Reed, said the staff is pleased with the
service, and Reed’s patient education coordinator found the content "excellent."
"We think it’s a useful source of information for our patients," Swisher
said. Not a single Walter Reed patient has complained about the network. "In
fact, we’ve had compliments on it from our patients and our own staff,"
Swisher added. "We have confidence in the ability of our patients to distinguish
between the programming and the commercials."

Jarvis speculates that Commercial Alert has singled out the Patient Channel
precisely because it is so successful. "It’s a standard practice of small,
low-budget activist groups," Jarvis said. "They pick a big fish to
target to get publicity for their cause."

The Nature of Education

Lately, however, the agency that accredits hospitals has taken an interest
in the Patient Channel. A key area of attention: one of the Patient Channel’s
main selling points to hospitals. Until late June, marketing materials created
by GE Medical Systems, the corporate unit that operates the Patient Channel,
told hospitals that its programs helped fulfill national standards for patient

Those standards require "that a patient receive education and training
specific to the patient’s assessed needs, abilities, learning preferences and
readiness to learn, as appropriate to the care and services provided by the
hospital." But on April 24, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) informed Patient Channel executives that the programs
in no way meet its requirements for patient education. Patient Channel programming,
said Robert Wise, vice president of standards for JCAHO, is one-size-fits-all,
and individual patient needs are not addressed. Tailoring education to those
specific needs is at the heart of JCAHO requirements. Wise said Patient Channel
officials promised to remove any statement about joint commission standards
from future marketing materials.

Accreditation standards aside, Patient Channel officials insist the programming
provides real education, noting that several of the programs have been produced
at the request of hospitals; others have been produced in collaboration with
reputable medical organizations. For example, "Living with Cancer"
was produced with the cooperation of the National Cancer Institute (NCI), which
helped producers outline topic areas, develop the script and find experts to
interview, Dan says. NCI will also review the final program, according to Dan,
for "accuracy, currency, objectivity and completeness."

Other reviewers will include the same three advisory boards that regularly
vet Patient Channel programs—a medical advisory board, an ethics, legal and
regulatory board, and a hospital advisory board—all including prominent doctors
and medical professionals, says Dan. The reviewers, except for those on the
hospital advisory board, will be paid a stipend by the Patient Channel, he adds.

One of the programs that appears regularly is "HealthWeek," which
is produced by Newsweek Productions in association with Maryland Public Television
and washingtonpost.com.

Angell isn’t buying the education rationale. "The notion that pharmaceutical
companies can educate patients and doctors is absurd," she says. "For
some reason, pharmaceutical companies are getting a pass on this." She
doesn’t see much difference between the programming and the advertising since
drug companies are paying for both. "It’s all advertising," she said.

In his April letter to the Patient Channel, Dennis O’Leary, president of JCAHO,
warned that patients may not be able to distinguish between the programming
and the marketing, and he urged GE to add "prominent disclaimers"
to its programming that say the hospital does not endorse the products or services
mentioned. He asked hospitals that air the channel to carefully review their
ethics policies for potential conflict-of-interest problems.

In response, Patient Channel officials have agreed to more clearly delineate
between ads and programming.

Ruskin said that’s not enough. "The name implies that it is a product
of the hospital. That’s very different from other television stations. ‘I Love
Lucy’ does not imply that it is a product of the hospital and its doctors."

Ruskin says allowing advertisers to pitch products to patients under the guise
of education is a case of the fox guarding the henhouse. "Anyone who broadcasts
to an audience of the sick and vulnerable has a heightened responsibility not
to deceive or mislead. That is especially true of drug ads, because even when
drugs are used properly, they may cause death or serious illness."


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