The Oath
A frequently used rationale for healthcare awareness campaigns is increasing patient compliance by offering celebrity endorsements, educating the audience to the dangers of untreated disease or the hope for an improved outcome, or otherwise motivating patients in the audience. This can be a tricky task.
One such awareness campaign, promoting better control of Type 2 Diabetes, was launched one year ago by the American Association of Clinical Endocrinologists (AACE) with funding from GlaxoSmithKline (GSK). The program featured two hooks:
1. The project, titled “State Of Diabetes In America,” featured a state by state comparison showing the percentage of inhabitants who were above the A1C goal of 6.5%. The tone of the program can be discerned by the headlines on the net, which are similar to those appearing in newspapers when the campaign began,
New Report Reveals America’s Diabetes Health is in Jeopardy
Philadelphia’s Diabetes Health May Be in Jeopardy
St. Louis’ Diabetes Health May Be In Jeopardy
Houston’s Diabetes Health May Be in Jeopardy
2. The campaign advocated that patients “Take the Oath to Get Your Blood Sugar Level Under Control.” The web site went on to urge patients to “join the many Americans with type 2 diabetes, who … are making a personal commitment to better diabetes management by getting their numbers down.” Those taking the Oath vowed to talk to their clinicians about treatment, eat and exercise appropriately, test blood sugar routinely, and take medications as prescribed. Oath-takers also received a “Diabetes-Friendly Cookbook.”
So, what’s not to like?
Now, we get to the afore-mentioned tricky part, i.e., There is no free lunch.1 In this case, the message that the AACE and GSK clearly saw as a wake-up call that would alert and motivate diabetic patients to work with their clinical teams to control their pathology was seen as off-putting or worse by at least some of the intended audience2.
Before going on, I must disclose that I have no scientifically valid evidence about the impact of this campaign. I do, however, have my own thoughts about the compliance angle and some anecdotal indicators. And, thanks the especially courteous spokesman from the AACE, I have confirmation that one goal of the State of Diabetes program was indeed motivating better compliance from Type 2 Diabetics. The spokesman also informed me that in the past year, “more than 3500 people took the oath.” No data about effects on compliance were collected.
I was interested in the campaign in part due to my interest in patient compliance; from that point of view, I found the data that described significant noncompliance fascinating. I was also interested in part due to my own diagnosis of Type 2 Diabetes; as a diabetic, I personally found the the oath – well, annoyingly paternalistic. I informally contacted five acquaintances with the same diagnosis, all of whom responded with versions of the my own response, real or metaphorical shoulder shrugs, and mild to moderately disparaging comments along the lines of “Who cares?” and “Screw that.” Two of these individuals, both doctors themselves, spontaneously pointed out that taking the oath online (another option was printing out the oath to discuss with ones physician) automatically gives GSK permission to “market or advertise to you regarding the medical condition(s) in which you’ve expressed an interest, as well as other general health related information from GSK,” 3 leading them to speculate that that this was “just another way for the drug companies to sell their stuff.” Again, I have to emphasize that these were casual conversations,4 not a survey and it may be that the AACE and GSK could produce pages of testimonials lauding the Oath; my point is only that not everyone viewed this as a positive or even neutral message; some saw it as a negative one.
I also found a couple of pertinent comments from blogs focusing on diabetes.
… A campaign has been launched in which Type 2’s can take an oath to achieve better control; a list of 4 vague points that include taking meds as prescribed, setting goals and testing blood glucose levels, and speaking to his/her doctor about management plans. No mention of multidisciplinary teams that include CDE’s, Dieticians, Endocrinologists, etc. and no reference to Clinical Guidelines. But I suppose it’s a place to start.
Candid Diabetes
… Unfortunately, the State of Diabetes concept isn’t breaking much new ground. It consists of the standard diabetic recipe book, a website that shows you how your state stacks up against the rest of the nation (interesting but not particularly helpful), and an online patient “Oath” that puts the entire burden of making the healthcare relationship work on the patient. Certified diabetes educators, registered dietitians, and other crucial members of the diabetes team aren’t even acknowledged.
The AACE deserves kudos for their tighter control goals of an A1c of 6.5% (as opposed to the American Diabetes Association’s 7% recommendation). But recipe pamphlets and scary statistics aren’t enough to drive people to bring their blood glucose under control. If the AACE works in tandem with other diabetes organizations to provide tools and support and make diabetes management less of a ‘do-it-yourself’ project and more of a community effort, we can affect some real improvements in diabetes compliance. We’re all in this together.
dLife
And the point is …?
1. By my lights, the underlying premise of the “State Of Diabetes” program, that sounding the tocsin will rally the troops, is another example of the unwarranted belief in the myth that Noncompliance Can Be Eliminated By Educating The Patient, Motivating The Patient, Eradicating Or Relieving Side-effects, Simplifying The Treatment Plan, …
2. It appears self-evident to me that if one buys into the notion that an awareness campaign has the potential to motivate an individual to make healthy changes, one necessarily assumes the risk that there is an equal potential for a campaign to produce unintended, negative results. In the case of the “State Of Diabetes” Oath, it seems possible that the message may have alienated some patients from their medical support team rather than motivating them to work more closely with their clinicians. Of course, this is especially significant in my view, given that my primary principle of better compliance is the need to bring the patient, his or her clinicians, and other stakeholders into alignment with a single, shared objective: to implement the best workable treatment plan for the patient.
I cannot calculate the overall consequences of this (or any other) disease awareness campaign. I am convinced, however, that if enhancing compliance is the goal, than the AACE should consider a less preachy alternative, such as the “we’re all in this together” approach suggested by the quoted bloggers.
Footnotes
- See also “No good deed goes unpunished” “The road to hell is paved with good intentions” “You can’t please everyone” [back]
- I’m limiting my discussion to compliance-related issues. Arguments have also been made that disease awareness campaigns are sometimes only camouflaged advertising for pharmaceutical companies, that they inappropriately skew research funding, and commit a variety of other sins that fall under the aegis of disease-mongering, but these fall outside my focus on compliance and are beyond my expertise. [back]
- The complete phrasing, which is clearly displayed on the web site, reads “By providing your name, address, e-mail address, and other information, you are giving GlaxoSmithKline (GSK) and companies working with GSK permission to market or advertise to you regarding the medical condition(s) in which you’ve expressed an interest, as well as other general health related information from GSK. GlaxoSmithKline will not sell or transfer your name, address, or e-mail address to any other party for their own marketing use.” [back]
- I’ve often suspected that I have an abundance of cynical, hypercritical acquaintances, which could explain a lot [back]
Cultural Differences & Presumed Noncompliance »
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