Toenails, advertising, media and disease.

A recent item on a BBC news program got us thinking. It said that brushing your teeth twice daily would prevent heart disease. Nothing new to your average grunt in General Practice here in Northernshire as the link between dental disease and heart disease which has been known for decades.

Many of the diseases we see in General Practice have been around as long as human beings have. Examples are such life threatening things as colds and sore throats.

Amazingly, despite their self limiting nature and relative lack of harm, the human population continues to expand. It has more than doubled since the 1960s with most of the world being completely untouched by the NHS.

Other diseases are of far more recent an origin for example HIV/AIDs and we have seen these diseases and watched them evolve from their infancy.

Another group of diseases we have noticed over the years are born of the media and advertising and for years people rarely did anything about them.

Take the humble toenail.

For many years in general practice we have been asked occasionally to look at what is known locally as “manky nails”.

These are usually the result of fungal infections. Until recently the drugs used to treat them would have had to have been used for 2 years in order to try and get a cure which was not guaranteed.

We would, because of the length of time needed to treat, usually have sent nail clippings of to the labs, and wait 6 weeks for confirmation that it was a fungal infection before starting treatment.

By which time most punters would have lost interest as there was no instant medical “fix”. A week in politics is a long time. A manky nail for 6 weeks without life saving treatment is far longer and as manky nails are not harmful they are quickly forgotten.

Word obviously got round and we only rarely saw people asking for treatment.

More recently there seem to be loads.

Now, unless we have missed something, there does not appear to have been a “Careless nails costs lives” campaign run by the Ministry of Information/Health that has raised public awareness. Certainly we as doctors are not doning our capes and ringing our bells shouting “bring out you manky nails, there’re killing yer”.

However, if one watches daytime TV or looks in magazine or newspapers there appears to be loads of advertisements for products for the life threatening scourge of the manky nails.

Most of the products being touted aren’t that good compared with more recent anti fungal drugs which can really cure these infections in months rather than years. This means that people are happier to treat for a few weeks or months rather than years.

Coupled with the continued search for the body perfect and the fact sandals are making an appearance as temperatures sore into the high teens Centigrade the demand for treatment for manky nails has grown year on year here in Northernshire particularly in the grossly obese for whom appearance is a huge issue. “I can’t wear sandels with manky nails that is so gross you have to do something for them”.

Another disease that has been with us for years was impotence.

We reviewed our referrals a while back and found that in the 5 years BV (before Viagra) there was one patient who had requested help and referral to a specialist for this problem when there was nothing available (apart from loads of dubious quack medicines).

In the year AV (after Viagra) there were 5 referrals for impotence. This was, we suggest, due to the appearance of many excellent and articulate practitioners in this sensitive field for example, and we are not making this up (North), Sister Nollie Biggins (albeit way down South from us) who has featured on the national media.

The advertising for Viagra we recall was clever in that it hit the television screens before we as GPs could get any prescribing information and so patients were demanding it before we knew anything much about it.

Another clever use of the media and advertising to create interest in a “new” disease and demand for that which had been lived with for centuries?

Now is there anything wrong with this you may ask? Well we don’t know is the answer. We have just noticed subtle changes in what people now consider to be a disease worth wasting a doctor’s time for which a few years ago they would have quietly lived with.

Is the treatment of manky nails a major public health issue? Probably not - unless undiagnosed diabetes is the cause.

The treatment of impotence?

More difficult as it is not a public health issue* but for men, and their partners, it is possibly a private happiness issue.

(*certain studies suggest it may be linked to heart and vascular disease before anyone starts).

Such was the concern of the Party that they issued dictates as to who can or cannot have it on a prescription. Look and see who qualifies. You are compelled to pay for your “sex” drugs but see a prostitute and pay for intercourse and that is a crime?

Compare the above two examples with statins for heart disease which were once touted by the media as the “new aspirin”, initially denied by the Party as “too expensive”, and are now being thrust down the throat of anyone whose cholesterol is considered too high after coming off patent so the cost plummeted.

Same basic problem, namely heart disease, same risk factors, different media hype lower cost and therefore political outcome. The illness and treatment stayed the same throughout apart from the drug cost. The advice however changed.

The crux of this for doctors is that we are meant to provide the best for the patient.

Fungal nail infection, no real treatment, ignore.
Fungal nail infection, real treatment, treat.
Local managers then object as treatment costs rise.

Impotence. No real treatment. Ignore.
Impotence. Real treatment so try to treat. Media hype regarding treatment leads the moral minority to jump on the bandwagon and that which helps is denied to most.

Statin good, statin media friendly, statin expensive = no statin.
Statin cheap, political imperative, statin for all.

The media and advertising affect us all whether we like to admit it or not. Whether this is good, or not, in medicine is debatable as if you go to the US the advertising of drugs and medicines is so much more in your face than it is here.

Despite this relatively low level of advertising of medical products here in the UK it does impact on general practice as diseases that were previously ignored are now thrust into our faces by the media inspired patient.

None of us here at ND Central have a problem with disease. What we do have is a problem with is non life threatening illnesses, present for many years, being presented abusively to receptionists as emergencies.

We return to our initial observation of lack of tooth brushing causing heart disease. How long before a commercial manufacture launches an anti heart disease toothpaste for your children that will prolong their lives?

Will that lead to lobbying and approval of a toothpaste that will be advertised and plugged on TV and so every parent will want it on prescription for their kids to help them as childrens’ prescriptions are free in the UK?

And then there will be the can I have 5 packs of toothpaste just in case my not seeing an NHS dentist and smoking 40 a day which I can afford will make me get heart disease but if I use my childrens’ medicine for free I won’t?

Praise be to the Party for “knowledge”. If only the grunts on the ground had some input into media output. We might just then see some proper illness for which treatment would make a life changing difference.

Unfortunately we don’t and we have to follow whatever tune the media plays to our patients.