The Pill: When Commerce Presents Itself as Medicine
Dr. Miroslav Balchev
You see an advertisement.
A person your age looks tired. Forgetful. His heart is no longer what it used to be. His blood vessels seem to have started aging. His joints hurt. He no longer has the energy he once had.
A few seconds later, everything changes.
The product appears.
A pill.
A capsule.
A syrup.
A powder.
And the person is smiling again.
Walking.
Working.
Playing with the grandchildren.
His memory is good.
His heart is calm.
Life is wonderful again.
The advertisement ends.
And one thought remains in the viewer’s mind:
“Maybe I should do something for my health.”
And this is where the problem begins.
Because the advertisement has not made a diagnosis.
It has not measured the blood pressure.
It does not know the cholesterol level.
It does not know the kidney function.
It does not know what medications the person is already taking.
It does not know whether the person even has the condition that the advertisement has so skillfully reminded him of.
But it has already offered him treatment.
The Pill Is Not the Enemy
Let us make this clear from the very beginning.
This article is not against medicines.
That would be absurd.
Antibiotics save people from infections that once killed them.
Insulin transformed type 1 diabetes from an almost certain death sentence into a disease with which a person can live for decades.
Antihypertensive medicines prevent strokes.
Statins reduce cardiovascular risk in appropriately selected patients.
Anticoagulants protect some people with atrial fibrillation from ischemic stroke.
Anesthesia, antiepileptic medicines, cancer therapies, and countless other drugs are among the great achievements of civilization.
The problem is not the pill.
The problem begins when the pill stops being an answer to a medical need and becomes a product for which a need must be created.
Two Opposing Questions
A doctor should begin with the question:
“What does this person need?”
A seller inevitably begins from the opposite end:
“Who can we sell this product to?”
There is nothing unusual about either question.
The doctor practices medicine.
The seller practices commerce.
The problem begins when the second question starts to look like the first.
When selling is presented as healthcare.
First the Anxiety, Then the Product
The human body is perfect territory for advertising.
We all age.
We all forget things sometimes.
We all get tired.
We have all experienced headaches, insomnia, heavy legs, bloating, joint pain, digestive problems, or worries about the heart.
After the age of 40, 50, or 60, the list naturally becomes longer.
This creates an almost unlimited advertising market.
“For memory.”
“For the heart.”
“For circulation.”
“For blood vessels.”
“For the liver.”
“For the prostate.”
“For the joints.”
“For immunity.”
“For energy.”
“For detoxification.”
“For good sleep.”
Gradually, a person may be left with the impression that the normal human body is nothing more than a collection of insufficiently supported organs, each waiting for its own tablet.
Medicine Begins with a Diagnosis. Advertising Begins with a Suggestion.
This is the fundamental difference.
If a patient has high blood pressure, we first measure it.
If we suspect diabetes, we test blood glucose and HbA1c.
If we are concerned about the kidneys, we measure creatinine, eGFR, and examine the urine.
If we suspect a heart rhythm disorder, we perform an ECG.
In other words:
data → diagnosis → risk assessment → decision → treatment.
The advertising model can easily reverse the sequence:
product → anxiety → assumed problem → purchase.
That is not medicine.
That is marketing.
“Maybe You Have…”
One of the most effective advertisements does not tell a person:
“You are ill.”
That would be too much.
It simply asks questions.
Do you get tired?
Do you forget things?
Do you get up at night?
Do your legs feel heavy?
Do you sometimes have gas?
Do you have difficulty falling asleep?
What person beyond a certain age would not answer “yes” to at least one of these questions?
After a few questions, the viewer begins to construct the beginning of a diagnosis himself.
And then the product arrives as the natural solution.
This is an extremely effective psychological mechanism, because the person no longer feels that someone is selling him something.
He feels that he himself has discovered a health problem.
When Normal Aging Starts to Look Like a Disease
This is especially fertile ground.
The memory of a 70-year-old is not the same as that of a 20-year-old.
Muscle mass changes.
The skin changes.
Sleep changes.
Vision changes.
This does not mean that we should passively accept every decline as inevitable.
But there is a danger that every normal age-related change can be turned into a problem waiting for a product.
And then a person no longer simply grows older.
He gradually becomes a permanent consumer of anti-aging products.
Fear Is an Excellent Salesman
Few motivations are as powerful as fear for one’s own health.
“Protect your heart.”
“Do not wait until it is too late.”
“Take care of your brain.”
“Protect your blood vessels.”
These are extremely powerful messages.
No one wants a heart attack.
No one wants a stroke.
No one wants dementia.
And if a sufficiently convincing association is created between that fear and a package, the purchase no longer feels like spending money but like responsible care for one’s own health.
But sometimes the most responsible action is precisely:
not to take the product.
First, find out whether you need it at all.
“Sold Without a Prescription” Does Not Mean “I Should Take It”
This is another important misconception.
Over-the-counter means that a product may be supplied without a doctor’s prescription under certain conditions.
It does not mean:
risk-free;
suitable for everyone;
useful for prevention;
necessary with advancing age;
compatible with all other medicines.
Even well-known medications can cause problems when used without an indication.
Aspirin, for example, can reduce the risk of thrombosis in certain patients and at the same time increase the risk of bleeding.
The very same action may be therapeutic in one situation and undesirable in another.
There is no “good pill” outside the context of the individual person.
What About Food Supplements?
Here the boundary between health and commerce becomes even more blurred.
Supplements are sold as tablets, capsules, and powders.
They stand next to medicines.
Advertising sometimes uses medical terminology.
White coats appear, along with diagrams of organs, blood vessels, and joints.
But a food supplement is not a medicine simply because it is placed in a blister pack.
In the European Union, health claims for foods and supplements are regulated: they must be clear, accurate, and scientifically substantiated, and misleading claims are prohibited.
In practice, however, the impact of advertising does not come only from the words that are literally spoken.
There is music.
Images.
Medical symbols.
Pictures of the heart or brain.
Words such as “supports,” “cares for,” “maintains.”
And sometimes a person can be left with a much stronger impression than what the advertisement has actually stated in legal terms.
Why Don’t They Advertise the Test?
Imagine a television commercial:
“At the age of 60, check your blood pressure.”
“Test your LDL.”
“Have your HbA1c measured.”
“Check your kidney function.”
“If you smoke — stop.”
“Walk every day.”
“Lose excess weight.”
“Get enough sleep.”
That would be an excellent advertisement for health.
Except there would be nothing to sell at the end.
Blood pressure has no trademark.
A walk has no patent.
Quitting smoking does not come in attractive packaging.
Normal body weight does not come in a blister pack.
And this is where the fundamental conflict lies:
not everything that is good for health is a good product to sell; and not everything that is a good product to sell is necessary for health.
Does “Advertising Medicine” Exist?
No.
The term itself is actually a contradiction.
If the decision about which product to use comes from advertising, it is not a medical decision.
Medicine uses advertising, the pharmaceutical industry uses marketing, and doctors work within an economic environment — these worlds inevitably meet.
But we must know where the boundary lies.
In the European Union, direct advertising to the public of prescription-only medicines is prohibited. Control over pharmaceutical advertising is carried out by national regulatory authorities and through industry self-regulation.
This restriction is not accidental.
The average person does not have enough information to assess the complex balance between indications, contraindications, drug interactions, and risk.
But Commercial Influence Does Not End with Television Advertising
This is the larger issue.
The World Health Organization now uses the concept of “commercial determinants of health.”
WHO includes among the mechanisms of commercial influence marketing, the shaping of consumer preferences, lobbying, political influence, and the funding of research and medical education. At the same time, the organization emphasizes that the private sector also makes an enormous positive contribution through the development of medicines, vaccines, and health technologies.
This clarification is important.
There is no need to turn pharmaceutical companies into an enemy.
Without them, modern medicine would be impossible.
A company has the right to profit from a medicine it has developed.
Research costs money.
Manufacturing costs money.
Quality control costs money.
No reasonable person expects medicines to be developed without economic interests.
The problem is the conflict of interest.
The patient has an interest in receiving as much treatment as necessary.
The manufacturer has an economic interest in selling more of its product.
These two interests may coincide.
But they are not identical.
And What About Lobbying?
The word itself is often used as a synonym for corruption.
That is not correct.
Lobbying can be a legal and transparent form of participation by interested parties in the political process.
A pharmaceutical company has the right to present its position.
Medical organizations do too.
Patient organizations do too.
Scientists do too.
The problem begins when economic power starts to exert disproportionate influence over rules, information, or the scientific environment.
WHO identifies lobbying, political donations, the funding of scientific research, and influence over the information environment as possible mechanisms of corporate influence.
Therefore, the question is not:
“Is there lobbying?”
The question is:
“Is there transparency, are conflicts of interest known, and who has the final say?”
The final word should belong to the evidence and to the interests of the patient.
When We Treat the Laboratory Result Instead of the Person
There is another danger here.
An abnormal laboratory value can become the center of all attention.
But a person is not LDL.
He is not HbA1c.
He is not PSA.
He is not a blood pressure reading of 145/90.
Laboratory values are tools for assessing risk and disease.
They are not patients in their own right.
Good treatment must constantly ask:
What real benefit will this person receive?
Will he live longer?
Will his risk of heart attack be lower?
His risk of stroke?
Will he function better?
Will he feel better?
And what will the price be in adverse effects?
“Just in Case”
Perhaps these are the three most dangerous words in self-medication.
I will take something for the heart — just in case.
Something for memory.
Something for the blood.
Something for the liver.
A few vitamins.
Magnesium.
Omega-3.
Aspirin.
Some kind of “nootropic.”
Not because there is a proven problem.
But because a person wants to do something.
This human desire is understandable.
Passive waiting makes us feel defenseless.
The pill creates a sense of action.
Every morning we take it and feel that we are investing in our future.
But in medicine, doing something is not always better than doing nothing.
Sometimes the correct medical action is:
to measure;
to observe;
to lose weight;
to move more;
to stop smoking;
to stop drinking alcohol;
not to start an unnecessary medicine.
The Pill Is Extremely Convenient
It has one enormous psychological advantage over lifestyle change.
It takes seconds to swallow.
A walk takes an hour.
The pill does not sweat.
Physical activity does.
The pill does not require us to lose weight.
It does not force us to change our diet.
It does not take away the cigarette.
It does not require us to go to bed earlier.
That is why it is easy for a person to feel that medicine is contained in the package.
But many of the most powerful preventive measures will never be packed into a blister.
The Paradox of the Well-Informed Patient
The internet was supposed to make the patient better informed.
And it did.
But at the same time, it made him more accessible to advertising.
In our pocket, we carry a device that knows what we search for.
If we search once for “forgetfulness,” “prostate,” “high cholesterol,” or “knee pain,” very soon we begin seeing products for exactly those problems.
Advertising no longer needs to find its audience.
The audience has identified itself.
And that is why medical literacy today means more than simply knowing more about diseases.
We must learn to recognize when someone is using that knowledge to sell us something.
The Most Important Question Before Every New Pill
It is surprisingly simple:
“What exactly am I treating with it?”
Then come several more:
How has it been proven that I have this problem?
What is the expected benefit?
How large is that benefit?
What is the risk?
How long should I take it?
What will happen if I do not take it?
Is there a non-pharmacological alternative?
These are medical questions.
“I saw it on television” is not a medical indication.
“At my age, it is probably useful” is not one either.
An Advertisement Can Still Have One Benefit
There is an interesting paradox.
Advertising can frighten a person about his own health.
That is not necessarily a bad thing if he then does the right thing.
Not buy the advertised pill.
But go and have his blood pressure measured.
Check his blood sugar.
Check his cholesterol.
Get examined.
Think about his weight.
Start walking more.
Then the advertising impulse has been transformed into real prevention.
Advertising says:
“Buy.”
Medicine should answer:
“Check first.”
Victims of Pills?
Yes, there are such people.
There are adverse drug reactions.
There are drug interactions.
There is overdose.
There is unnecessary treatment.
There is polypharmacy — especially among older people.
But it would be unfair to describe patients simply as “victims of pills.”
The pill has no intentions.
It is a chemical substance.
In the right person, at the right dose, and for the right indication, it can save a life.
In the wrong person, it can be useless or dangerous.
Therefore, the real problem is not:
The pill.
The real question is:
Who decided that we needed it — the diagnosis or the advertisement?
Real Prevention Has No Commercial Break
The best prevention is often boring.
Blood pressure.
Cholesterol.
Blood sugar.
Body weight.
Physical activity.
Sleep.
Vaccinations.
Preventive examinations according to age and risk.
Giving up cigarettes.
Reasonable nutrition.
There is no miracle.
There is no “revolutionary formula.”
There is no capsule that can replace all of this.
And there probably never will be.
The Pill Should Be a Consequence, Not a Beginning
Perhaps this is the shortest conclusion.
The pill should come after the question.
After the examination.
After the measurement.
After the diagnosis.
After the assessment of risk.
After weighing the benefits and harms.
And sometimes, after all of that, the answer will be:
“Yes, you should take it.”
Then the pill is medicine.
At other times, the answer will be:
“You do not need it.”
And that is medicine too.
Because medicine is not measured by the number of tablets prescribed.
It is measured by the benefit to the person.
When Commerce Puts on a White Coat
There is nothing wrong with commerce.
There is nothing wrong with profit.
There is nothing wrong with a company being rewarded for a medicine it has developed and that saves human life.
But the white coat has a different purpose from the commercial label.
That is why the boundary must be clear.
Medicine asks: “What is best for this person?”
Commerce asks: “How do we sell this product?”
Both are legitimate human activities.
But only one of them should decide what goes into the medicine cup on our bedside table.
Let the product not go searching for a disease.
Let the disease, when it truly exists, search for the right treatment.
And the next time an advertisement makes us feel that we absolutely must “do something for our health,” let us really do something.
Measure.
Test.
Ask.
Check.
And only then, if necessary —
take the pill.
