Saturday, May 17, 2008

Ethics of the Big Lie in DTC Advertising

Last week I argued that while - in my view - the societal consequences of direct to consumer drug advertising (DTC) are, on balance, more bad than good, our deeply held first amendment value on free speech is the trumping value in deciding whether or not to allow DTC.

An article in the forthcoming May 22 issue of the New England Journal of Medicine -"DTCA for PTCA -Crossing the Line in Consumer Health Education?" takes the issues a step further. Drs. Boden and Diamond, both cardiologists, discuss an advertisement for a coronary stent manufactured by the Cordis Division of Johnson & Johnson that was aired during a New York Jets/Dallas Cowboys football game on Thanksgiving Day. DTC for drugs is well established. DTC for devices like stents is new.

The article describes in detail the characteristic way in which the device is presented in an overly rosy manner. It article is written in a scholarly and balanced manner that is far removed from the emotional dynamite of DTC. The authors speak in the careful manner of academic experts, as in their conclusion that "a device is being promoted to millions of people who are ill equipped to make judgments about complex therapeutic issues that even specialists continue to debate."

I deliberately chose an unbalanced title for this posting to make a point. If, as I believe we should, we follow our national commitment to maximum free speech in allowing DTC, we need equally vigorous emotional dynamite in response. As important as academic counter-detailing is for the education of physicians, evidence-based academic prose won't move the public. We need emotional counter-detailing for public education.

Well-informed, hard-hitting blogs that track commercialism in health care like the Carlat Psychiatry Blog, Health Care Renewal, and Hooked present timely postings about advertising lies. As good as Boden and Diamond's New England Journal article is, it appeared six months after the Thanksgiving TV ad for the stent.

At a Harvard Medical School ethics forum a few years ago one of the speakers presented a professionally developed TV advertisement on overuse of antibiotics that featured a movie star talking about why she didn't use antibiotics when her baby had a cold. But who will buy air time for ads like this?

YouTube is a start. But the audiences are still small. "Big Pharma, big bucks," a high quality nine minute story, has only had 7,000 viewers. Bill Maher's anti-Pharma rant has done better - 270,000 viewers.

If a 10% - 20% surcharge on advertising fees paid for by the drug and device industry was levied, it could fund substantial advertising to promote rational use of drugs with the same emotive force that is currently driving overuse, misuse, and economic waste. This is a policy option that needs to be explored. Free speech is an important value. But so are public health and not bankrupting Medicare!