The ‘post-truth’ world: How it’s drifting into medicine

The Economist, a British weekly, recently declared “post-truth” to be the 2016 word of the year. For those not familiar with the phrase, The Economist describes it this way: “Politicians have always strayed from the truth, but shame kept them in the general postcode.” Not in the post-truth world.

While this phrase was certainly borne out of a certain disrespect for the truth from politicians, its use is certainly not limited to the political world. A few recent interactions of mine show how the philosophy of post-truth is drifting into the medical world.

For example, about a year ago my practice purchased a MonaLisa Touch, an FDA-approved fractional CO₂ laser approved to treat dyspareunia. And it works. I’ll concede that at first I was a doubter as the idea of taking a female with debilitating painful intercourse and using a laser probe to treat her vagina seemed, well, unwise. But it works. The studies (limited as they are) report between 80% and 90% success (Climacteric 2015; 18:219-25; Curr Opin Obstet Gynecol 2015; 27:504-8), and after a year of treatment with well over 100 women treated, our results are that good also.

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The problem with the laser has to do with what it does anecdotally, but for which it does not have an FDA approval. As we all know, postmenopausal women are at higher risk of urinary tract infections secondary to menopause induced atrophic vaginitis. Local estrogen creams can help this but can be expensive and annoying. The studies on the laser show that it can also reverse the pH changes associated with menopause and so should (and very well may) help reduce the risk of UTIs. Importantly though, this is not an FDA-approved indication so at my practice both in talking to patients and in our advertising of the laser, are very careful not to claim this as an official benefit.

But not everyone is so fastidious. Another physician in town recently purchased the machine and sent out flyers advertising it to what seems like every woman in town. (I learned of these flyers as my wife received one in the mail.) In addition to describing the proven benefits for dyspareunia, he also claimed it worked (“Say goodbye to…” was his exact phrase) to recurrent infections, urinary symptoms, urinary incontinence, and gray hair. OK, he didn’t mention gray hair, but all the rest he certainly did.

And it’s misleading. I too would love to be able to tell my patients that a pain-free 5-minute in-office procedure will stop their recurrent infections, but until the FDA says I can advertise that, it’s at best off label and at worst wrong. The Federal Trade Commission has a website that lists its recent settlements for false advertising. Further, simply do a quick Google search and you’ll find dozens of articles on other examples of false or misleading advertising.

Shame on him for these claims. The laser is a true game changer for many women without stretching the truth.

Next: Pediatric ERs

How about pediatric ERs? Of the three hospital systems in town (our new little friend now included), one of them is associated with a major local children’s hospital with direct on-site access to a multitude of pediatric subspecialists. And one is not. I’m not claiming that this children’s hospital system has every pediatric subspecialist known to man, but it certainly has the majority, including a pediatric urologist.

Recently, the other hospital system started heavily advertising its “Peds ER.” There is now a sign on the hospital and numerous advertisements around town. I didn’t think much of them until a recent call weekend, when a 4-year-old patient with a complicated urologic history showed up in the ER. There was a question of torsion. This patient follows with the pediatric urologist in town and when I asked the patient’s mom why they came to this ER instead of the other hospital where her pediatric urologist works, she immediately pointed out the sign on the hospital advertising its new pediatric ER.

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It turns out the concept of what defines a “Peds ER” has already been litigated. A lawsuit in 2015 argued that a pediatric ER should only be staffed by ER doctors with pediatric training, and the courts ruled against this. Additionally, both the American College of Emergency Physicians and the American Academy of Pediatrics have guidelines on how to staff a “Peds ER” and neither requires specifically fellowship-trained pediatric ER doctors.

Again, in the spirit of honesty, my business card declares that I am “Board Certified in Adult and Pediatric Urology,” but nowhere on our practice web page do we seek out pediatric patients. Our staff is well aware of our policy to check with the physicians before booking any pediatric patient because while a simple circumcision patient is welcome in my clinic, this small-town plumber is not stepping in the same room as an uncorrected exstrophy patient (NICU consult to help stabilize the patient and prep for transfer notwithstanding).

Shame on the hospital for thinking that simply declaring its previous ER a “peds ER” magically makes it so. I would love to ask the CEO of this hospital where he would prefer to take his child-a hospital staffed with physicians specifically trained in pediatrics or a hospital without them.

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I apologize if I’m ranting. I’m a young urologist, still new to the real world, and I’m trying hard not to become bitter. But it’s tough. I feel that I spend more time in clinic trying to educate my patients on the misinformation they see on TV or in print than I do actually practicing medicine.

I know that advertising works and there is a whole profession of incredibly intelligent people whose entire purpose in life is to design clever advertisements to encourage people to buy things. I guess it’s just the simpleton in me who wishes that there was more truth in what people say. But perhaps this is the post-truth world we live in.

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