A look inside a doctor's mailbox
Most of us are familiar with what was
once a doctor’s
constant companion —that little black bag packed with mysterious
tools of the trade. But what about the contents of a typical doctor’s
mailbox? That material, I contend, reveals more about modern medical
practices than anything found in any MD’s carryall.
Recently, I examined two separate stacks of mail, gathered over two
months by Dr. Warren Bell, a Salmon Arm, B.C., family physician. One
stack contains a collection of plain, understated, and professionally
penned letters, brochures, and notices. The material includes invitations
to medical education courses sponsored by drug companies; and offers
on how to make money by learning vanity procedures such as skin tightening,
cellulite reduction, and hair removal.
Bell, however, is not a typical doctor so there’s a lot that’s
not in this pile. Absent are the reams of pseudo-medical journals, drug “information,” and
other advertising mailed free and unsolicited to almost every doctor
in the country.
Bell estimates he gets about 10 per cent of the mail a conventional
doctor does. That’s because 30 years ago, soon after graduating
from medical school, he wrote a firm but polite take-my-name-off-your-list-or-else
letter to the Canadian Direct Marketing Agency, the company hired by
the drug industry and others to mail material to doctors.
“I was astonished and amazed at how much of it there was,” Bell
recalls. “I was inherently suspicious of it . . . If you’re
not careful, your mail will be full of enormous amounts of public relations
bumpf from the drug industry.”
University of Victoria drug policy researcher, author, and former letter
carrier Alan Cassels agrees. He recalls delivering mail 12 years ago
on a route that included a building housing about 10 doctors’ offices. “Each
doctor,” Cassels says, “received a six-inch stack of mail.
Every day.”
Of course, no doctor can read all the material that comes through their
door, let alone keep up with the frenetic pace of medical science research.
Consider: From the mid-1960s to mid-1990s, the number of published randomized
clinical trials increased from 100 to 10,000 articles; in fact, nearly
half of all medical literature ever published has appeared in the past
five years.
But, says Bell, reading is not the point. “The idea is not to
read the articles, necessarily. It’s to thumb through them and
get the images from the advertisements for various drugs into your subconscious
mind.”
Before delving into the second stack of mail, it helps to know a bit
more about Bell. While still in training, he began to learn about the
intimate relationship between medicine and the drug industry. Unlike
the majority of his colleagues, he refused to see pharmaceutical company
reps in his office or have any drug company logos on things such as pens,
notepads, chart organizers, or calendars in his possession.
Bell has a keen interest in what he calls “non-pharmaceutical
approaches” to healing. He is currently president of the Association
of Complementary and Integrative Physicians of B.C. That explains the
contents of the second stack—a colourful collection of generously
illustrated material from sellers of herbal, mineral, vitamin, and other
biological remedies. They feature hysterical headlines in colossal type
that scream such things as: “Deadly Cancers Vaporized by Harmless
Natural Enzymes” and “Fight Diabetes with Three Teaspoons
of Red Wine Vinegar.” Also included are several tracts trashing
conventional drug therapies.
Bell admits that much of the alternative bumpf is hard to take. Yet
he is relatively tolerant of what he calls their “strenuous language.” Why?
Are outlandish claims and snake-oil tactics easier to swallow than the
calm and ostensibly reasonable material from pharmaceutical companies?
Bell says there is a crucial difference between the two.
“The biological remedies are being sold into the ‘real’ market—like
a bazaar in Marrakech,” he says. “So it’s messy, hyperbolic,
and loud. Big Pharma, on the other hand, plays a smoothly deceptive game
of pseudo-obeisance to doctors, all the while using every trick in the
book to persuade us to prescribe: false data, exceptional and unfailingly
non-confrontational behaviour, bribes, gifts, you name it. All that I
find far more irritating because it is so utterly false.”
Ponder that next time your doctor’s postman cometh.
Alicia Priest is a Victoria-based writer who loves her family doctor
despite the contents of his mailbox.
