Friday, April 11, 2008

Kate Gets Annoyed by Direct to Consumer Drug Advertising

In case you haven’t watched primetime network news recently, there are three things for sale in America: cars (to burn the fossil fuel Americans are not supposed to use), investments (to build the nest eggs Americans are presently without), and drugs (you thought I was going to throw in another parenthetical here, didn’t you? I am a sly one).

There are few things I love as much as direct-to-consumer (DTC) drug advertising. And by love, I mean ‘respond to with some form of dyspepsia.’ But I bet if I could just make it through the ads, they would sell me something to cure that gurgly feeling I get from seeing an older couple dance in their kitchen after Mr. Whoever pops a Cialis. Eww.

But what makes me even gurglier deep in the depths of my stomach (I think my spleen may be involved too—something about rage) is that fact that, somewhere, there is some man who now wants to go see his doctor and ask if there is a little blue pill that is right for him. And it’s not just that I’m grossed out by erectile dysfunction drugs. It’s that I can hum the Vytorin song in my head. I know that Lyrica might relieve my fibromyalgia symptoms.

As I have mentioned before, our whole medical system is based on an imbalance of information. We go to doctors because we don’t know how to fix ourselves and they do. But that is changing—kind of. Between WebMD and the Merck Manual online, we can diagnose ourselves… right? Okay, maybe we play into our own hypochondria and exaggerate our symptoms. But really, we don’t even really need doctors, do we? Heck, I can navigate a drop-down menu as well as some guy who went to med school—and my wireless costs a lot less than those four years of his life he’ll never get back.

So we have diagnosed ourselves. The next step is obviously to analyze the armamentarium and decide if Lipitor is right for us. (Incidentally, if you are making this particular decision, you are one of about 12 people left in your time zone who are not already on Lipitor. Public health experts actually joke about putting it in the water.) So now the drug companies tell us—the self-diagnosing, prescription-demanding public—what to ask for when we see our doctor. And since our doctors are running late and our appointments are short, they don’t always have the time—or make the time—to do a comparison of brands or recommend (gasp!) generics. Instead they write the prescriptions for the name brand drugs of our choosing.

You want numbers? Here are numbers. Percent of patients who have seen a DTC ad: 86. Percent of patients of asked their doctor about a drug they saw in an ad: 35. The kicker: of patients who went to the doctor specifically to ask about a drug, percent of patients who walked out with their prescription of choice: 75. And we wonder why the drug companies are spending more on marketing than on research and development.

So here are my problems with DTC advertising.

First, it plays on people’s fears and hypochondria to get them to buy a product. I just find that kind of wrong. Furthermore, they play on people’s fears while downplaying the risks and side-effects of these substances. Except for that one psoriasis drug. I can’t remember the name, but I saw an ad for it yesterday, and death was very clearly stated as a potential side effect. I thought that was pretty ballsy. Although if I remember death but not the name, I guess it wasn’t a very good ad.

Second, we live in a world in which “first do no harm” can sometimes mean prescribing a drug if it won’t hurt the patient and it will make him or her go away. As a result, DTC advertising is potentially causing overuse, driving our growing national health expenditure (NHE) higher and higher. Moreover, it takes less time to write a script than to develop an exercise plan with a patient, and the availability of drugs can compromise our message about the importance of preventative measures and health preservation.

Finally, DTC advertising is not about pharmaceuticals. It is about branding. And as long as we keep buying in to the shiny packaging and the funny ads, it’s going to be difficult to reduce our exploding NHE through the use of generic drugs.

*Kate does not endorse any of the drugs named in this post. She just happens to concede that their brainwashing tactics are impressive.

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