I Would Prefer Not To

The big envelope from the Gigantatron Pharmaceutical Managing company was emblazoned with "May Contained Protected Health Information," a HIPAA-engendered bit of jargon that means "there's stuff about a patient inside," so, rather than chuck it unread in the circular file along with all the other medical marketing junk mail, I opened it.

It was packed full of papers. I scanned the the "Dear Doctor" boilerplate and, on page 2, found the patient and drug in question, "Mr X.," to whom, a few months ago, I had prescribed "prednisone 10mg," a standard treatment for asthma-gone-wild. I pulled him up in the EMR and reviewed the case, fretting inwardly about the pile of new Mr X's queued up in walk-in clutching their Gigantatron cards and their chests. I remembered Mr X. His doc, also in the EMR, had been treating him for a respiratory infection with an antibiotic Mercedesbenzafloxacin, and he had showed up in walk-in wheezing. Hence the prednisone. And a standard inhaler, which I shall call PuffGrand

I turned back to the massive offering from Gigatatron. They began by informing me there were two Gigantatron "preferred" inhalers , PuffGrand (GlaxoSmithKline) and PuffSupreme (AstraZeneca.) This puzzled me because, as I said, I had given a prescription to Mr X for his own, personal PuffGrand inhaler ! Gigantatron didn't seem to be acknowledging this. How could it not be aware ? Gigantatron knows all, after all. It knew about the (generic) prednisone ! If I had tried to prescribe PuffOther, not on their "preferred" list, I would have heard right at the point of Mr X. hitting the pharmacy and being asked for $350 in exchange for the right to breathe. So what was up ?

I read on. After the puzzling Dear Doctor boilerplate letter about Mr X, prednisone and "our 2 preferred inhalers" was a massive packet of glossy info about "PuffSupreme." Nothing about PuffGrand, no head-to-head studies comparing PuffGrand and PuffSupreme, just reams of glossy text about PuffSupreme. I was growing increasingly annoyed.

What was Gigantatron trying to tell me ? That some preferred drugs are more preferred than others ? Was it even aware that I had given Mr X. his prednisone with a side of PuffGrand and, on a second visit, I discovered that he'd done great ?

I turned back to the EMR and scrolled upward. Looks like Mr X had visited his PCP after his two visits to me. I read Dr. PCP's progress note. "Patient went to walk in and got antibiotics. I think he has a virus and antibiotics will not help."

WHAT ! WHAT !!! Wait a minute, Mr. Dr. PCP, if that's really your name, YOU, sir, are the one who prescribed Mercedesbenzafloxacin in the first place !!!!! I gave no freaking antibiotics ! I prescribed prednisone and PuffGrand and now I am being doggedd by the hellhounds of Gigantatron ! And you, sir, are vilifying ME in the medical record as an overprescriber of the ridiculously strong and expensive and unnecessary antibiotics that you, yourself prescribed ???

Now I had a double annoyance roiling me and, probably, even more patients queuing up.

I glanced back at the mailing. There was some

very small print

on the bottom of the first page that I had missed. I squinted at it.

All became clear.

Funding for this communication was provided by AstraZeneca LP -- the purveyors of of PuffSupreme, the "preferred" inhaler I did NOT prescribe to Mr. X..

I slumped in my chair. I had fallen for it. It was the oldest trick in the book. It was a drug ad dressed up in Protected Health Information clothing. It was a trojan horse, and the marketing armies were swarming, triumphant, all over me.