Let the Patient Beware

Direct-to-Consumer Medical Advertising

“Let the Patient Beware”

Laurence Mermelstein, M.D.

Watching the Olympics turns most of us into gymnastic fans for one week during the summer every four years.  We all remember the American All-Around champions of the past, Carly Patterson and Mary Lou Retton.   But Mary Lou has garnered significant attention the last few years as more than just an Olympic gold medalist – she has become a national spokesperson for the Biomet corporation after under going a total hip replacement in 2005.

Mary Lou was a 37 year old active mother of 4 who had been suffering for 7 years with progressive worse hip pain. She was diagnosed with a form of “hip dysplasia” – an abnormally developed hip joint from birth.  Her hips obviously did not pose a restriction for her in her athletic career, but the shape of her hips along with approximately 150,000 vaults, and an uncountable number of back handsprings caused her hip to deteriorate into end-stage arthritis.  She described her pain as “excruciating and unbeareable” at times.

“I am pain-free and can’t thank Biomet enough for changing my life,” states the now 40 year-old Mary Lou Retton after hip replacement surgery. “My new M2a-Magnum™ hip has truly exceeded my expectations.”

If you want to hear more about Mary Lou’s hip surgery, all you have to do is go to Biomet’s web site and learn all about the “M2a-Magnum™” hip.  Surfing this web site was both interesting and unsettling to me as an Orthopedic surgeon.  This “DIRECT TO CONSUMER ADVERTISING” is a relatively new development in orthopedics and has elicited both very strong negative and supportive responses. Direct to consumer orthopedic advertising started back in 2003 when Jack Nicholas was found pushing his exciting new Trident hip replacement. Now, most implant companies have at least patient-friendly web sites which emphasize the specific benefits of their products.

This direct-to-consumer marketing is “unethical and should be made illegal,” says Dr William Maloney (Stanford University, CA). “Patients are coming in to see us with information from the internet or from television or other advertising and are asking for a particular type of implant or a specific surgical procedure,” Maloney said at a press briefing during the American Academy of Orthopaedic Surgeons (AAOS) 2005 meeting. It creates real problems, he said, as often what patients come in demanding is inappropriate for their particular case, and they are preempting decisions that should be made by the surgeon after careful evaluation of each patient’s case history.

I’m not sure that I feel as negatively regarding this trend in “patient information”. Whereas the physician expert should be the final determinant of the most appropriate medical or surgical care, I think it is critically important to involve the patient in the decision process. The more  accurate  information the patient has, the more appropriate the patient’s questions are.  In my opinion, the best patient results are obtained in the best informed patients, especially with respect to the limitations of the surgical procedure and reasonable post-operative expectations.

That being said, most patients need to understand that ALL CASES ARE DIFFERENT, and that a fantastic result in one patient does not guarentee a similar result in the next patient.  I think, and hope, that most people reading about Mary Lou’s story understand that most patients have very little in common with the case of a 37 year – old, 4 foot 9 inch ex-Olympic athlete.

Lastly, when it comes to using ex-athletes as medical spokespeople for orthopedics, the long term results in these unusually young active patients come into question. Procedures such as joint replacements do not have infinite life-spans. One needs only to recall the saga of Bo Jackson to temper one’s enthusiasm for these procedures.  Bo Jackson was arguably the best two sport professional athlete this country has ever seen.  A hip injury while playing running back for the Oakland Raiders in 1991 led to a hip replacement procedure in the spring of 1992. At the time, Bo was 29 years old. He rehabilitated his joint extensively to the point of returning to professional baseball. Bo never returned to baseball after the strike shortened 1994 season and eventually required a second surgery on the same hip in 1995 to revise the loosened implants.

In this age of medical consumerism,  the patient needs to be careful about not only the accuracy of the information they receive, but also the APPROPRIATENESS of the information.  A relationship with a surgeon the patient can trust is of upmost importance in sorting this information and in achieving the best possible outcome.