Friday, May 9, 2008

Drug Advertising - What the Public Thinks

If you want a balanced analysis of the pros and cons of how the U.S. public thinks about direct-to-consumer (DTC) drug advertising, yesterday’s testimony to the House Committee on Energy and Commerce by Mollyann Brodie, Vice President and Director of Public Opinion and Media Research at the Kaiser Family Foundation, is the place to start.

DTC drug advertising is a prototypical good-versus-good conflict. Kaiser Foundation surveys show that the public is torn about DTC. Everyone has an opinion, since 91% of adults have seen or heard prescription drug ads!

53% see DTC as mostly a good thing. 40% see it as mostly bad. 67% agree with Pharma’s claim that “prescription drug ads educate people about available treatments and encourage them to get help for medical conditions they might not been aware of.” But 66% think DTC encourages people to take drugs they don’t need, and 77% say that DTC makes drugs too expensive.

Surveys tell us what the public thinks about right and wrong, not what is right and wrong. But the Kaiser Family Foundation findings have important practical implications.

I believe that if we could study the actual impact of drug advertising we would find it to be largely bad, with relatively little accurate education of consumers about health conditions and treatments, and much unnecessary medication use and cost without benefit. But we won't be able to do those studies - it's too hard and too expensive.

Free speech is as deeply held as any American value. That's why the first amendment prohibits "abridging the freedom of speech." Pharma's claim that freedom of speech protects DTC will prevail, and even though I don't like DTC, I think it should prevail.

But the first amendment doesn't prevent regulation of how DTC is conducted, and the public is moving towards readiness to endorse tighter controls. 43% believe the government should do more to “make sure statements about benefits and side effects made in Rx drug ads are not misleading.” Whereas in 1997 33% trusted DTC most of time time, in 2005 only 18% did so, and 34% hardly ever or never trusted ads.

In good-versus-good conflicts like this one we could continue arguing until the cows come home without reaching a consensus. Some will make free speech the top value. Others will give preference to the public's health. But the polls point towards a potential compromise that would respect both key values. With good leadership we could tighten regulation so that truly educative DTC was allowed but duplicitous DTC was not.

This isn't the direction the Bush era FDA has been going in. (See previous posts here and here.) But along with free speech, the right to chuck out an administration is another deeply held American value!


Anonymous said...

Published on

Your Television as you doctor?

Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.

Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t 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, which is to increase sales and grow their market and, 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. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.

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, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and 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. And 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 advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.

Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.

Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional 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. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads 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 over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their 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”

Dan Abshear

Lily said...

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.

Jim Sabin said...

Hi Lily -

You're absolutely right. I just looked up Caduet, and 30 pills cost between $150 - $200. I can't fault the company for trying to sell a higher cost product, but any insurance company that pays for it rather than for the two separate ingredients should be ashamed of wasting its enrollee's money. If an individual understands what Caduet is and decides for herself that the minor convenience is worth $125 per month, she's entitled to make that choice, but if I were her physician I would advise her to make better use of her funds.

Thanks for your thoughtful and important comment!