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.