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TV personality Phil McGraw — best known as "Dr. Phil" — will be making the media rounds soon talking about his experiences living with Type 2 diabetes for more than 25 years.
But be aware: This isn't an objective and noble effort to raise awareness or destigmatize a condition that millions of Americans face.
Instead, Dr. Phil has been hired by the drugmaker AstraZeneca as a paid spokesperson — and this presents all sorts of thorny conflict-of-interest problems.
"These campaigns create a blurriness between marketing and public health messages," says Dartmouth physician-researcher Steven Woloshin. "People tend to view them with less skepticism, particularly when there is a trusted celebrity spokesperson."
The Dr. Phil case is an example of a common Big Pharma tactic known as "disease awareness." "The idea is that a spokesperson, often beloved celebrities like Kelsey Grammer or Paula Deen, helps shed light on a particular disease. In turn, they build the base of patients who take a drug company's medications.
These campaigns usually involve some subtle hawking of a company's pharmaceuticals, often at a time when there's a push within the company to ramp up sales of a particular drug or just before a new drug is coming to market.
So they're better thought of as covert drug ads masquerading as friendly advice about a disease from a trusted source.
Sponsored campaigns don’t typically present unbiased information
AstraZeneca is sponsoring the Dr. Phil campaign. AstraZeneca makes a diabetes medication called Bydureon. Clearly, the drugmaker doesn't have an interest in giving the public objective information about all the different treatments available for diabetes — the kind of information that can help people make evidence-based choices about the harms, benefits, and trade-offs of various therapies.
A spokesperson told me that Dr. Phil was chosen for this campaign because he's been "successfully using one of our medications, Bydureon, to manage his diabetes since 2012."
Woloshin, who has been tracking the celebrity health phenomenon with his colleague Lisa Schwartz, explained that the FDA only approved Bydureon as a second-line drug — meaning doctors should try other medications first.
The drug also carries a black box warning — the FDA's strongest alert — about potentially increasing the risk of thyroid cancer. Here is a quote from the official information for prescribers:
"BYDUREON is not recommended as first-line therapy for patients who have inadequate glycemic control on diet and exercise because of the uncertain relevance of the rat thyroid C-cell tumor findings to humans. Prescribe BYDUREON only to patients for whom the potential benefits are considered to outweigh the potential risk"
Dr. Phil's campaign may educate a few people about diabetes. That would be a win — and it's the main reason celebrities can be good vehicles for talking about health. But in a case like this, where the information coming out of the campaign is likely to be lopsided, the effort could do more harm than good, leaving the public with a skewed picture of the disease and potential treatment options.
Dr. Phil is not a doctor — but he plays one on TV
Dr. Phil has the cachet of the "Dr." moniker at the front of his name — even though he holds a doctorate in psychology and is not a licensed psychologist.
"We wonder if [the drug company is] concerned about people assuming 'Dr.' means he is a physician," Woloshin pointed out.
This tactic has been used before. In 2008, Pfizer ran an ad campaign for Lipitor featuring Dr. Robert Jarvik. The effort spurred New York Times editorials and congressional hearings over the concern that people would assume Jarvik was actually a practicing doctor even though he was not licensed to practice medicine.
AztraZeneca seems to have found a workaround. The spokesperson for the campaign explained that Dr. Phil wouldn't be talking about the drug per se — but he will be accompanied by a medical doctor who will surely fill in any blanks. That doctor happens to be on AztraZeneca's payroll too.
