Sean Neill is a South African-born, British-trained anesthesiologist, who
recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care.
Watching television in America takes some getting used to. Apart from the accent, it is strange to hear companies marketing drugs directly to the consumer. Not only do they sell their own brand, but they actively name and shame their competitors’ products. During a commercial break there may be two different brands of antihistamine telling you how bad the other is.
Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Although the drug industry is mounting major campaigns to have DTCA allowed in Europe and Canada, the only two developed countries where it is currently legal are the U.S. and New Zealand.
Studies have shown that increases in DTCA have contributed to overall
increases in spending on both the advertised drug itself and on other
drugs that treat the same conditions. For example, one study of 64
drugs found a median increase in sales of $2.20 for every $1 spent on
DTCA. It has been reported that 10 of the leading 12 brand-name drugs
with DTCA campaigns have sales in excess of $1 billion annually.
DTCA may have some benefits for consumers. In 1999 and 2002 the FDA conducted two national telephone surveys which found that consumer ads prompted many patients to actively seek out newly available medical treatments for various (usually chronic) conditions and that patients had become increasingly motivated to ask better questions of their health care providers.
Recently the New England Journal of Medicine published an editorial, DTCA for PTCA — Crossing the Line in Consumer Health Education? This discusses whether advertisements for a new drug-eluting coronary stent present a "fair balance" of information about the risks and benefits. How are patients supposed to assimilate and evaluate this sort of technical information cramped into a 60 second emotive commercial?
Should this kind of advertising be allowed in the UK? Personally I don’t think so, but perhaps patients should be given the opportunity to choose a brand name instead of the cheapest generic.
Filed Under: Uncategorized
Tagged: International, Pharma, The Industry, The Insider's Guide To Health Care, Uncategorized Jun 30, 2008
Doctors often have difficulty keeping up with the new drugs and the thousands of existing ones.
If you don’t like advertising, how would you propose that people get information on new drugs?
“how would you propose that people get information on new drugs?”
Certainly not from drug ads. These are marketing tools that have nothing to do with the appropriatness, safety or effectiveness of the drugs. And the ads don’t give the doctor more time to research a drug, just more pressure from the patient to use it.
I do not intend to advocate drug ads. I am looking for information.
Sean criticizes advertising, but does not offer an alternative solution. I am interested in his and your thoughts on how to give patients an easily accessible means to research new and existing drugs.
Let the drug companies market them as they used to, by visits to the doc’s office – less of course any financial incentives/offers/enticements they may want to use. That way the technical aspects of the drugs can be discussed, with at least one party concerned about healthcare not sales volume. Making splashy ads for some molecule adjustment that extends patent is not in the interest of the patient.
One plus of watching Spike TV, which has a lot of “CSI” re-runs is the lack of drug ads! Cars and violent movies yes.
If you start watching TV and begin thinking there are too many drug ads you’re watching an old-fogies channel.
Then again, how many times can you watch ads for Wendy’s and Verizon wireless?
The question is still out there: how do patients learn about new drugs? The door has been left open for advertising to consumers.
However, what may be more dangerous is advertising to physicians. This is not being discussed.
In addition to ethical issues such as the impact on prescribing behavior or potential for influential relationships, this type of advertising also contributes significantly to increased pharmaceutical costs.(http://www.rwjf.org/pr/product.jsp?id=17638; http://www.kff.org/rxdrugs/3057.cfm)
I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new when something old or generic would do the job for cheaper.
Turning Half Truths Into Complete Lies
We often see advertisements on television for some type of medication — usually one involved in a large-market disease and the commercial is sponsored by a big pharmaceutical company. This is called direct to consumer (DTC) advertising, and doctors would prefer they did not exist.
Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of these commercials greatly increased. Now, the pharmaceutical industry spends around $5 billion annually on this gigantic media effort. Normally, the commercial airs within a year of the drug’s approval, which raises safety concerns and involves money spent that could be applied to greater uses, according to many. But, we are dealing with a corporation here.
The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective — to increase sales and grow their market — in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. The most interesting ones are for erectile dysfunction (ED) during primetime TV, with the real possibility of children watching. Further surreal is that these particular commercials seem to have ED sufferers portrayed as those who could probably run marathons, which is not realistic from a clinical perspective.
DTC advertising is also a catalyst for and similar to disease mongering. Disease mongering is the creation of what some believe to be medical flaws. It is illustrated by the drug companies through exaggeration and embellishments via various media sources as an avenue for propaganda — often seen with DTC advertising. Though the flaws may not be medical, the corporate creation of these questionable human ailments that do not require treatment, possibly, may be an attempt to develop a particular medical condition to acquire profit.
One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. It is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments being advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
Also, DTC ads normally discuss a single treatment option when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the physician, as they assess your health, not your TV or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of America and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professionals remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. After viewing a DTC ad, many seek out a doctor visit and request whatever product that was advertised, which makes the doctor’s situation quite cumbersome. So the doctor and patient relationship is altered in a negative fashion since most DTC advertised drugs require a prescription.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some of our over-prescribing habits, which will benefit all of us in the long term. And the health care system can regain control of its purpose, which is far from financial prosperity.
Men of ill judgment oft ignore the good that lies within their hands till they have lost it.
— Sophocles
Dan Abshear