A Solution to the DTC Advertising Dilemma

The pharmaceutical industry has been settling into its “good guy” role in recent days; first committing to $80 billion in cost savings over ten years to help defray the cost of health reform and then forking over $150 million to finance an ad campaign championing the administration’s plan. (Of course there was that slight fall from grace when it looked as if, in exchange, PhRMA had secured guarantees that Medicare would not be able to negotiate drug prices…click here for Maggie’s take on that.)

But what else can the industry do to help burnish its image with the American people? How about finally consenting to some common-sense limits on the barrage of prescription drug ads confronting consumers every time they turn on the TV or open a magazine? While a complete ban is probably not possible (in part because such a ban might violate the First Amendment) how about making prescription drug ads a lot more educational and a lot less like a hard sell for a new BMW?

Ads Hike Spending On Drugs

Direct-to-consumer advertising (DCTA) has been a boon for drug companies ever since Congress passed the Prescription Drug Marketing Act in 1987. Spending on consumer drug ads reached $5.0 billion last year, according to Neilsen Media Research and Americans see up to 16 hours of drug advertising on television each year. These slick appeals for sleep aids, impotence drugs and a host of other remedies, clearly pay off. Studies show that every dollar spent on DTC ads generates four dollars in additional sales of new drugs that are often only marginally better than far cheaper, generic versions or older drugs.

Proponents of direct-to-consumer drug ads—mostly representatives from pharmaceutical companies—claim that these appeals have an educational function, bringing ill patients into their doctor’s offices to receive sorely needed therapy. This benefit can be real when the advertised condition is serious and under-treated—hypertension, for example—and the treatment is highly effective and safe relative to its alternatives. But when was the last time you saw an ad on TV for a hypertension or cancer drug? Instead, aggressive advertising is much more common for therapies directed against so-called “lifestyle” problems like thin eyelashes, insomnia, toenail fungus and erectile dysfunction. And their side-effects can be quite serious.

Studies have shown that direct-to-consumer advertising has fundamentally changed the way doctors and patients communicate, mostly for the worst. Fewer than 10% of physicians believe direct-to-consumer advertising (DTCA) is a positive trend in health care. Doctors report that they now spend more time explaining to patients why an expensive new drug is no better than the one they already take, or that the patient isn’t suffering from a nebulous condition like fibromyalgia, just the normal aches and pains of aging.

Physicians feel pressured by patients who come in asking for these newer, more expensive (but not necessarily, better) medications by name. In a recent survey conducted by Consumer’s Report, one-fifth of the respondents said they had asked their doctor to prescribe a drug they saw advertised on television or elsewhere: Some 70% of physicians complied with this request.

Proposed Legislation

With criticism mounting from consumer groups and pressure focused on reducing health care costs, there is a new sense among legislators that the time might finally be right for limiting DTC drug advertising. Three bills have been proposed so far, including:

1) Families for ED Advertising Decency Act—sponsored by Representative James P. Moran, (D-VA)– this House bill would give the FCC power to ban ads for prescription sexual aids like Viagra and Cialis from prime-time television, on decency grounds.

2) Henry Waxman (D-CA), Chair of the House Energy and Commerce Committee, supports a moratorium on DTCA for two or three years after a new drug is introduced. This action, also supported by the Institute of Medicine and the American Medical Association is necessary to prevent wide-scale advertising to the public of drugs—like Vioxx—whose long-term health effects are still unknown. Two-thirds of the drugs that are withdrawn from the market due to safety concerns have been on that market for less than three years.

3) Say No to Drug Ads—Introduced by Rep. Jerrold Nadler (D-NY), this legislation would amend the tax code so that drug companies could no longer deduct DTCA spending as a business expense.

Opposition—Not Just the Drug Companies

Opponents of limiting DTC ads argue that moratoriums on pharmaceutical advertising would violate the First Amendment protection for commercial speech. Avoiding that battle is probably a good idea, because drug industry lobbyists aren’t the only ones making that argument. Drug companies are second only to the automotive industry in the amount they spend on consumer-directed advertising and in 2007, lobbyists representing media and ad agencies helped defeat Congress’s attempts to further regulate DTC ads. With ad pages down throughout the industry and networks vying for sponsors, the First Amendment arguments will only get stronger.

So, barring a ban on DTC drug ads, the best way to rein in misleading and manipulative marketing is to pass regulations that tightly control how these ads are structured. The FDA is supposed to be doing this already, by preventing the industry from making false and misleading claims. But when total funding for all of the FDA’s programs—including enforcement—is less than half of what Big Pharma spends on direct-to-consumer advertising, it’s clear that the agency just doesn’t have the resources to carry out this role. With more and more pharmaceutical advertising taking place on the internet—where, for example, it can be very difficult to discern drug company-sponsored sites from legitimate disease advocacy sites—the FDA’s ability to regulate this field has become exponentially more difficult.

Opponents of further regulation also like to point out that the industry polices itself. In 2005, PhRMA President and CEO Billy Tauzin announced that the industry group had adopted "Guiding Principles" that would promote patient education in DTC drug marketing and “foster responsible communications between patients and health care professionals to help patients achieve better health." According to Tauzin:

“With these principles, we commit ourselves to improving the inherent educational value of advertisements. Patients need accurate and timely information and should be encouraged to discuss diseases and treatment options with their physicians.”

Rebutting the Industry’s Arguments

But in an editorial in the Annals of Family Medicine, editor and physician Kurt C. Stange, says that FDA oversight and industry self-monitoring are not working. Neither approach has stopped drug companies from promoting drugs over healthy behaviors, or has lessened the deleterious effects the ads have on doctor-patient communication.

“How are communication and health fostered by manipulating patient-clinician communication toward drugs and away from health behavior, or by denigrating clinician recommendations for nonpharmacological health interventions? How does a broad-based medium designed to sell to the masses promote drugs in the individualized way that is essential for safety if the message largely reaches people who are not candidates for the drug? How does it improve public health to bombard the public with the message that life is happier, more fulfilling, more socially acceptable on drugs? What are the unintended consequences of the plethora of images and messages about health that are intended to increase patient demand for drugs?”

I have further questions for the industry: If the aim of these appeals is to be educational, then why do drug companies hire multi-national advertising agencies to design their ads, and not public health educators? Why are there no comparisons of therapies, clear information about risks vs. benefits and links to unbiased medical information? The answer is that today’s slick direct-to-consumer ads are really not designed to be educational; they are designed to boost drug sales and profits.

The Best Solution

So what’s to be done? First of all, Congress should consider Waxman’s proposal for a moratorium on DTC advertising on drugs that haven’t been on the market for at least two years. It shouldn’t be that much of a hardship for companies—only about 15% of DTC ads are currently for drugs that are less than a year old. Limiting drug ads in this way could also help companies avoid Vioxx-like situations where widely advertised and prescribed new drugs are found to have serious side-effects only after FDA approval.

In Congressional hearings on DTC ads that took place last June, representatives from Merck, Pfizer, Johnson & Johnson and Schering Plough told legislators that they already have a voluntary 6-month moratorium on advertising for new drugs. In reality, the companies need this delay in order to get their army of drug reps out
to sell doctors on the new drug before they are faced with patient requests for information.

Senators Bart Stupak and John Dingell told the companies that this wasn’t long enough—they want to see a two-year moratorium on drug ads. Waxman agrees, although he now says that he is open to reserving the moratorium to drugs that are the most risky. He told Time magazine in February:
"It doesn't have to be a full two years," Waxman says. "It's allowed to be limited to drugs that the FDA thinks might be a safety problem."

Besides the moratorium, it is essential that drug advertising be educational and not just play to consumer emotions. Because, seriously, prescription drugs are not BMWs. Most people are able to think critically about car ads: they recognize that with images of beautiful women, long winding roads and a background of jazzy music, they are being sold a dream of luxury and social status.  They also understand that they had better check out some price and performance comparisons before trading in the 10-year-old Escort.

By contrast, when the average person sees a television ad for Lipitor, for example (which had over $12 billion in sales in 2008) they hear “high cholesterol,” “reduces risk of heart attack by 36%,” and get about 45 seconds of an attractive actor talking about the drug’s benefits; some 15 seconds are a rushed litany of potential risks. The viewer also knows that the FDA approved Lipitor and he believes the agency also approved the ad—there is a level of authority and trust in these ads that is not implicit in car or beer ads.

But there is a lot about statins like Lipitor that isn’t mentioned in these 60-minute spots. In “Do Cholesterol Drugs Do Any Good,” John Carey of Business Week says that Lipitor’s benefits to people without significant heart disease are far less clear when the numbers are expressed this way:

“[F]or every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit.”

In fact, Carey writes, some of those other 99 might actually have been harmed by taking Lipitor for so long—experiencing side-effects that include muscle pain and cognitive problems. (See also HealthBeat’s two-part post on “The Cholesterol Con” here and here )

One of the most promising ideas for improving the educational value of drug ads is to have them include simple-to-read “fact boxes,” developed by researchers at Dartmouth’s Institute for Health Policy and Clinical Practice, that are similar to the nutritional information found on most packaged food. These boxes contain two sections: the top section lists what conditions the drug can treat and who should take the medication. The bottom describes the effectiveness of the drug—and how it compares with other treatments—as well as the percentage of patients who experience different side effects.

A study by the Dartmouth researchers  (which is available in the Annals of Internal Medicine ) looked at whether adding a drug fact box to DTC ads for prescription heartburn drugs helped consumers make better choices about medication. Some participants were given standard versions of ads for two heartburn drugs (with a long, fine-print text of drug information on the back) and others received the two ads with fact-boxes replacing the fine-print. In the end, some 68% of participants who got the drug fact boxes correctly identified the more effective drug; only 31% of those who got the fine-print were able to discern the superior treatment.

After meeting with the Dartmouth researchers in February, the FDA’s risk communication advisory committee unanimously urged the agency to require that drug fact boxes appear on all medication labels. They also recommended that they appear along with other drug information on the FDA’s website. Steven Woloshin, one of the Dartmouth researchers, says that he would like to see the fact boxes replace the fine print in DTC ads as well, but the FDA doesn’t have the authority to require this—that can only come from legislation. 

As the nation continues to struggle with health reform, deciding what to do about direct-to-consumer drug advertising might be pushed to a back burner. But that would be a mistake. We are just one of two countries (New Zealand is the other) that allows televised hawking of drugs; it’s probably not a coincidence that we also spend more than any other country on health care. These ads lead to overuse of expensive but not necessarily better drugs. They lead to the medicalization of health conditions that would be better treated with health and lifestyle changes. It’s time to require a lot more integrity from Big Pharma. It’s time to insist that they shift from the hard sell to helping us make informed choices about our health.

20 thoughts on “A Solution to the DTC Advertising Dilemma

  1. Maggie, you and many of your fellow blog commenters have done a great job in carrying the reform banner. Though I personally don’t agree with 100% of the ideas forwarded, I am a strong proponent of major change in our system. Unfortunately, PHRMa and the other big money lobbies have very effectively misled the American public to believe that health reform is bad for us. The big nasty is that the cost in $ and lives of doing nothing is far greater than the average Joe can contemplate. . . maybe next time when the crisis is past healing, we’ll do something substantial. Wow, how maudlin is that?
    You do a great job.

  2. Direct to Consumer Pharmaceutical Advertising = BAD
    Again, we need a summary list on one page. I love all the words Maggie, but I am not a good example of what a citizen responds to. Indeed, I actually didn’t read all your words before commenting.
    Maybe this is the thing that is a problem in communicating to the masses for all of the reformers. Simply too many words and not enough summary.
    It could be that the pent up feelings of those wanting reform and change are causing a spilling out of words in gushes. Maybe reformers are just wordy folks. Maybe reformers are impressed with their own command of the language and the beauty of prose.
    Still, the message is not getting through, so we must look critically at our message delivery.

  3. Naomi
    See this recent trial from BMJ in 2008. I find the DTC approach negative (I am being kind), but there are probably some salutatory effects on care if approached properly–as you mention, but it is unlikely we will ever see pharma go that route.
    Having said that, see this very novel study. I was surprised at the results. Data is mixed.

  4. If an extra-terrestrial would land on earth and watch these TRULY bizarre commercials they would get out of here real fast.
    Most of these DTC drug ads are beyond the wildest imaginations of the craziest among us and a direct assault on even a modicum of basic human intelligence.
    (The “undervoices” about all the side effecs including DEATH really drive me nuts)
    If I were a Big PhRMA CEO I would pull them out of sheer embarassment
    Dr. Rick Lippin

  5. I agree that DTC ads for drugs are probably not a good thing. But what about DTC ads for lawyers (“if you have a phone, you have a lawyer”), hospitals (“we care about you”), beer (“tastes great, less filling”), and Pop Tarts.
    Are any of these things good for you or necessary? And yet, in a free country, we allow purveyors of these products to advertise and assume that consumers are intelligent enough to make up their own mind.
    Why should we use a separate logic when it comes to pharmaceuticals? Instead, we should do comparative effectiveness research comparing the new drug to the existing drug and deal with demand by using co-pays. In essence we would be saying “You want the new drug? It is no more effective than the old drug but you can have it if you pay the higher deductible.” Then let the drug companies advertise their little hearts out.

  6. I agree with Legacy Flyer, I know, I can’t believe I said that so I guess we’re friends again, LF…I don’t like the ads either but I like trampling on free speech even less, so we’ll have to live with them. I also agree with Dr. Lippin…I can’t figure out why these ads are so effective to consumers, they’re just litter and by the end of the commercial I want to get as far away from that stuff as possible.
    Ed, I agree with you as well, and I’ve heard that before, Dr. Lippin didn’t you also say the same thing on another post somewhere? About short sentences…We need our own catchphrases. Maggie in your interview with Sam Something or other you said something to the effect “We pay them more to burn people and cut them up” that is not a direct quote but something to that effect, that was good stuff, say that more often. Money Driven Medicine=BAD but Maggie has a book by the same name so we have to come up with something else. Healthcare for Profit=BAD

  7. I can’t stand these ads, but the companies must be permitted to hawk their products. I am particularly revulsed when ads appear for various medications against ‘urolgical malfunction’, while I am watching TV with my kids. I would urge these companies to establish their own policies for accuracy and deceny in order to avoid government regulation. If the former effort fails, I favor the latter approach.

  8. Ed–
    This is Naomi’s post, but since you addressed me, I’ll respond.
    Our health care system is very commplicated. Much of what peolple think they know about healthcare is wrong. The problems are
    And the solutions are both complex–and require some sacrifice. (Or at least require that we give up some of the things we think we want–even if they are not good for us.)
    This is why the public is having a hard time wrapping its mind around the problem.
    Unfortunately, in this country we don’t place a high value on education; we rarely talk about ideas in any depth.
    In the U.S. the evening news is “easy listening.” (Try listening to the news in France.)When we debate politics, too often, we talk about personalities rather than ideas.
    Some of the most potent writing about the problems and what we need to do has been done by people like Atul Gawande. His very long, excellent piece in the June 1 New Yorker really broke through–not to everyone, of course, but to a surprising number of thoughtful people. There was no summary. You had to read the whole piece.
    Humphrey Taylor, chariman of the Harris Poll posted on The Health Care Blog recently, discussing what the polls show about what people actually think about health care reformo..
    The polls reveal that most people don’t really understand the problems and hope for a solution that would give them everythign they want–whenever they want it– and not cost them anything.
    In a discouraged moment, Don Berwick once said to me “perhaps Americans are
    just too immature for healthcare reform.”
    Humphrey concludes:
    “For example, a new agency to provide information on which treatments work better or worse sounds pretty good – but not if it is used to deny care that a doctor or patient wants.
    Most people do not seem to see a conflict between giving patients every test and treatment they and their doctors want, however expensive, and containing costs.
    As a pollster, I believe that it is unreasonable to expect the public to understand health care reform policies because the issues are so tough and so complicated. As H.L. Menken wrote, “For every complex and difficult issue, there is a simple solution – and it is wrong.” The enormous complexity of the issues and the emotional public response to misleading political rhetoric, make one think fondly of Bismarck’s famous maxim that the public should not be allowed to watch the making of sausages or laws . . You’ll find his whole post herehttp://www.thehealthcareblog.com/the_health_care_blog/2009/08/health-care-reform-what-do-people-really-want.html#more
    I’m not as pessimistic as he is. I do think some portion of the public can understand the issues–but only if they are willing to read–in depth–and think.
    People looking for a Cliff Notes to HealthCare reform will have to remain on the sidelines.

  9. Maggie,
    I agree on the superficial level with most of what you wrote. It’s all certainly true.
    On a more basic level though, I disagree.
    On a more basic level, this is a “shark pool” problem. Big sharks swim in rich waters. Rich waters attract big sharks. When the food supply gets thinner, the sharks swim elsewhere.
    Now, for the straight scoop, big picture, current status summary:
    1) Current Healthcare Industry = Rich Waters that Attract Big Sharks
    2) Big Sharks = Sociopaths who care most about Power, Money, and Sex
    3) Public Option = Way to make healthcare less rich waters so big sharks swim away.
    I love progressives, they are generally caring and nice people albeit with a seeming need to prove themselves. But my opinion is that nice folk just don’t understand the shark pool. The sociopathic big shark is outside the realm of experience of most regular folk. I’m raised as regular folk and I couldn’t believe the truth until it presented right in front of my eyes.
    So let’s stop throwing the chum in the water that attracted all these big sharks.
    Ten years later we will need the sharks again, I’m almost certain of it. But for now we need them to go elsewhere because they have become counter-productive in healthcare.

  10. Brad,
    Thanks for the link to the BMJ study. The health care system is very different in Canada where much of this study took place–with nationalized health care they operate with formularies and I would imagine docs are more comfortable saying “No” to patients who come in asking for drugs they’ve seen advertised on TV. Also, a letter in response to this article questions the study design and specifically, the types of drugs that were used in the study. One was for rheumatoid arthritis (hardly a lifestyle issue) and another was for Zelnorm, a drug for IBS that was banned a year later due to serious side-effects that included heart attacks. Worth taking a look at this letter: http://www.bmj.com/cgi/eletters/337/sep02_1/a1055#201612

  11. Naomi
    Of course, by no means was it perfect, but the method was clever: Look at english speaking canadians close to the border who see US ads, and compare them to french speaking canadians miles away who dont.
    Read the following, just to give a better overview. it is a nice summary, and talks a bit more about the drugs chosen, use, and explores the very good points of the letter writer.
    Again, I am no shill for pharma, i would prefer to see DTC ads go, but just as the pro literature has flaws, so does the nay set.

  12. Ed–
    I know all about the sharks.
    I spent 12 years as senior writer, then senior editor at Barron’s.
    I spent those years writing cover stories about Wall Street and Wasington.
    Interviewed and profiled, Ted Turner (who I actually liked), Donald Trump, Bill Gates, John Malone, Mike Eisner, Jeffrey Katzenberg,
    Bob Rubin, (who I also liked), Rick Scott (the crook who ran HCA/Columbia the largest for-profit hospital chain)–and so many others at the top of the CEO and Wall Strett food chain. . .
    In other words, I understand the “big sharks”
    I do understand how shark pool opeates.
    Occasionally, I nailed them.
    At one point, I wrote a story about Pfizer that cauesd the stock to stop trading in London on Sun. (Mon. here). Pfizer was making a heart device that someimtes broke in the patient’s heart, mimicking a heart attack while killing the patient.
    Pfizer concealed this fact.
    I had the telegram that Pfrizer sent to the scientist in Sweden who had developed the device, and now wanted to publish reasarch about the defect, warning people not to use the device.
    Pfizer’s telegram told him not to publish the research. It was dated in late December, and signed “Merry Christmas,” by a top Pfizer executive.
    When the Barron’s story come out in New York, the stock never opened for trading on Monday.
    I was delighted–not for myself, but for all of the people suing Pfizer (They settled, for a very large, but undisclosed amount).
    So, no, I’m not a “nice person” liberal.
    I’m a killer progressive.

  13. Dear Maggie,
    I think you missed my point or instead simply avoided it.
    All I am trying to say is that smart reformers need to simplify the message and hit a nerve before the opportunity slips away.
    I don’t read Huffington. I like O’Reilly better than Chris Matthews, but for some odd reason I am finding Rachel Maddow more appealing. I think Hannity and Olberman are both offensive. I read the WSJ and not he NYT. I voted against the winner of as many elections as I can recall.
    In other words, I’m not part of the choir and I’m not part of the other team. I’m that independent in the middle.
    The fringe of either side are fixed in their thinking.
    So its those of us in the middle who make the call, and we middle folks are pretty reasonable but we are awfully busy.
    Make simple points that ring true and add up to a conclusion.
    Democrats in conservative districts will fear public opinion. If your message can swing public opinion back just 5 or 10% towards the public option, healthcare gets a better shot at being repaired.
    My opinion is that you, of all people in the US, have the best book, documentary, facts and conclusions, but the big picture is being obscured.
    Take home message:
    Simplified Maggie Message = Maggie is a Hero
    Now, go and do good work grasshopper. Take a short recess, think, adjust, gain inner strength then let em have it in the final quarter of the game.

  14. BTW, when I said nice folks don’t understand the sharks, I was meaning those who never saw them up close, not you. Its obvious that you know that healthcare is being run by sociopathic types.
    Can you believe that Rick Scott is actually taken seriously as caring about us normal folk?
    Yet, to many, he seems credible. They simply don’t know better.

  15. Ed–
    Everyone is busy.
    Some things are more important than others.
    Given the fact that the problems are complicated, the solutions counter-intuitive, and so much misinformation floating around out there . . . .
    Health Care Reform cannot be–and shouldn’t be–
    framed in simplistic ways.
    Such attempts to frame in a few lines only provides a target for opponents, and generates more misinformation.
    The rising cost of health care is extremely important because, as White House Budget director Orszag points out, it is the greatest threat to the economy.
    Not the price of oil. Not
    China. Not global competiton. The rising cost of health care.
    To understand why, you would need to read a few paragraphs.
    To understand why reining in health care inflation would actually lift the quality of care you would need to read a few more paragraphs.
    To actually believe it–you would need to read more paragraphs filled with both statistics and narratives.
    Alternatively you could just watch O’Reilly–and never know what hit you when you wake up nine years from now, with a lower standard of living, and health care insurance that you can no longer afford (premiums twice as high as they are today.)

  16. Naomi,
    If it were up to me, I would ban DTC advertising for prescription drugs, at least from television, just as we banned cigarette advertising on TV since 1971. That said, I don’t think it’s a huge issue, though the media and progressives like to vilify drug companies and insurers because they’re easy, unpopular, and safe targets.
    As Humphrey Taylor eloquently discussed in his THCB post, the three most critical factors driving healthcare costs in the U.S. are utilization, misaligned incentives, and high medical prices.
    High utilization is part money driven, part defensive medicine and part trying to respond to sometimes unreasonable and unrealistic patient expectations. The fee for service payment model exacerbates the problem. Prices for episodes of care that include either an inpatient hospital stay or outpatient visit are often stratospheric, especially compared to what comparable services might be billed for in other countries. Specialists’ charges are also considerably higher here than elsewhere. While we pay more for brand name drugs in the U.S. as well, the use of tiered formularies and the considerable number of brand name drugs that have gone off patent in the last few years as well as more that will lose protection in the next few years, including blockbusters Lipitor and Plavix, are mitigating cost pressure on the traditional drug side. Specialty drugs, including biologics, are another matter.
    Any changes to Medicare payment policy that incorporate comparative effectiveness and cost-effectiveness research will be to the good. Since Medicare drives payment policy for most private insurers as well, they will be more than willing to follow Medicare’s lead, though they don’t have the perceived moral authority to lead such a change. They need Medicare to go first. They don’t need a public option to keep them honest, but they do need Medicare to drive sensible payment policy reform, which, as a byproduct, should reduce the need for cost shifting from Medicare (and Medicaid) to the private sector.
    While drug companies have at least put a contribution toward reform on the table, though progressives don’t think it amounts to much, I haven’t seen anything substantive from doctors or hospitals. What’s their contribution? I’ve raised that question numerous times, but I still haven’t heard an answer.

  17. Dear Maggie,
    Well, I give up. I hope this all works out better than it has been looking lately.

  18. Brad,
    Very interesting study:
    I have always questioned the efficacy of advertising. It used to drive me nuts when the hospital I worked at would spend lots of money on an ad campaign (usually featuring some trite and mindless phrase like: “We care about you”) while at the same time giving short shrift to the needs of my department or other departments.
    I was never convinced that these campaigns accomplished anything, although I have had administrators swear up and down that the campaign was effective. I have always felt that a hospital should use its money to improve its facilities, services and personnel, rather than wasting it on advertising.
    I wonder what would happen if a drug company stopped advertising, stopped paying lots of money to drug reps and instead plowed its money into research. Perhaps I am naive, but I am not sure that this would not be a better strategy FOR THE DRUG COMPANY.

  19. Maggie,
    Unfortunately this issue won’t be solved by fact boxes or a moratorium on new drug DTC advertising. In fact, it has recently intensified with the plethora of newly commercialized DTC genetic tests now available – and currently undergoing industry-wide regulation by the FDA today. If there’s one thing the drug companies excel at, it’s making money. Written in a piecemeal fashion, regulations will likely lag one step behind some misguided profit-generating strategies. Instead, it is time to develop and integrate comparative effectiveness programs for pharmaceuticals into health policy. Advertising should also require a disclosure regarding the drug’s comparative effectiveness with other drugs in it’s class. Throw into the disclosure that the medication may cost the patient more than a similar, equally effective drug, and I suspect patients’ requests for some branded medications will change.
    Physicians are at even greater risk of feeling the pressure of aggressive direct marketing. They get the double whammy: from patients and from drug representatives. In the middle of a harried day in the office, it’s easier for Dr. Jones to write Mrs. Smith a prescription to switch from a standard sleeping pill to a new, expensive sleeping pill that she’d like to try because her neighbor, Mrs. Jones, swears by it, than it is for him to convince Mrs. Smith to stay on her current medication. And, conveniently, the drug rep just dropped off samples at Dr. Jones’s office this morning, so it appears to be a win-win situation. But it is not. Big pharma can be the bully on the playground, supercharging the cost of healthcare unnecessarily.
    In the new healthcare paradigm there is an opportunity to realign the pharmaceutical industry’s incentives through thoughtful changes in healthcare policy. The goal should be to mitigate pressure placed by the industry on patients and physicians. Legislation should address the dos and don’ts of DTC advertising (ie/ no advertising to minors, such as the Differin campaign); create an independent, neutral entity to dole out drug samples to physicians offices and require comparative effectiveness information. That would be in the public’s best interest
    This is the moment of truth. Let’s hope our policy makers seize it and set forth regulations with the best interest of the public in mind.
    Alisa Cohen, MD
    Tufts University
    MPH 2012