Educational Media Reviews Online

A major impetus for the US Affordable Care Act of 2010 was not only to reduce the number of uninsured, but also to help control runaway inflation in the cost of our healthcare system. Although healthcare costs are not as high in other countries, many other countries also struggle to provide their citizens with affordable care. These two documentary films each address different aspects of this basic concern about the rapidly rising cost of medical care. Branding Illness, which was produced in France, focuses on a global marketing strategy called “disease branding” (1) used by international pharmaceutical firms to greatly expand the demand for their products in all countries, while Money & Medicine illustrates the medical, ethical and financial challenges of containing runaway healthcare spending in the United States with a series of doctor-patient stories filmed at the UCLA Medical Center in Los Angeles and the Intermountain Medical Center in Salt Lake City, Utah.

Branding Illness consists primarily of edited portions of interviews (with subtitles for those segments not in English) conducted with just over a dozen physicians, other academic scholars and experts from France, the United Kingdom, Canada, The Netherlands and the United States. These are interspersed with scenes from many pharmaceutical TV ads produced in Europe, Japan and the US that illustrate these marketing practices. The example cases discussed include the campaign of Eli Lilly to raise awareness of “pre-menstrual dysphoric disease” (PMDD) just when it’s patent on the anti-depression drug Prozac was about to expire. With Prozac’s ingredients rebranded and re-packaged in a new pill at a higher price, Lilly was ready with a potentially profitable new medication to treat this disease few had ever heard of before. Other example disease branding cases discussed in the film include the drug company campaigns to broaden the criteria for diagnosing high blood pressure and high cholesterol that have led to huge increases in demand for antihypertensive agents and statins; the campaign (with the help former senator Bob Dole) to raise awareness of “erectile dysfunction” and the resulting very high demand for drugs like Viagara and Cialis; the campaign to broaden the definition of depression to include a whole range of “bi-polar” disorders; and the more recent pharmaceutical industry project to convince the Japanese government to undertake a national campaign to change that society’s perception of depression from a serious mental disease associated with “shame” into a relatively mild and treatable “cold of the heart.”

Money & Medicine also presents edited portions of interviews, in this case with some twenty US physicians, hospital administrators and other healthcare financing experts, mostly working at the world-renowned UCLA and Intermountain medical centers. Using a series of specific illustrative patient cases at these two institutions, these expert clinicians and policy leaders discuss the factors that are driving up the cost of U.S. medical care and the challenges of controlling these costs. The film contrasts the strategies used at Intermountain to both lower costs and greatly improve average patient outcomes with UCLA’s more typical treatment strategies, where equally-highly-trained physicians and surgeons use cutting-edge medical technologies, but incur much higher costs and have patient outcomes than are no better and sometimes worse than the national averages. The example cases include end-of-life treatment choices (contrasting ICU hospital care with home palliative care); the factors that influence doctors and women to have their babies delivered by Caesarian section, a procedure which is both much more expensive and associated with more potential complications for the mother and infant; and the medical and legal pressures to make frequent use of expensive and potentially harmful diagnostic and treatment technologies such as heart catheterization procedures and proton therapy for prostate cancer.

Both of these films were written and directed by experienced documentary filmmakers with similar careers focusing since the early 1990’s on social and health policy issues. Eleven of Anne Georget’s 21 films produced for French television deal with historical or current health issues or challenges, including brain injuries, autism, artificial insemination, and the deliberations of a hospital ethics committee. Similarly 12 of Roger Weisberg’s 30 PBS documentaries have dealt with healthcare challenges including the mentally ill, nursing home care, teen pregnancy, and national health policy issues like our aging population, the uninsured, and the use of inappropriate medical technologies. Both filmmakers have received many awards (including an Emmy and Academy Award nominations for Weisberg) and these two excellent, provocative films both demonstrate their outstanding skills. Together these films could help stimulate productive high school or college classroom discussions about the challenges of providing high-quality, fair and affordable health care services. General adult audiences in the United States will, however, find Money & Medicine easier to follow, since it does not require reading the subtitles for Branding Medicine’s segments in other languages. Both films would also be welcome additions to college, university or large public library collections.

1. R Moynihan, I Heath, D Henry (2002). Selling sickness: the pharmaceutical industry and disease mongering. BMJ 324(13 April): 886-91.