Tuesday, December 21, 2004

Vested Interests in Direct-to-Consumer Drug Advertising

As a physician, my blood pressure goes up every time I see the ad about the little purple pill, or the ad involving the guy throwing the football through the old tire (but which is not about throwing, or footballs, or tires), etc., etc., etc. I am convinced that such advertisements provide almost no education to patients. But they probably persuade quite a few to pressure their physicians for drugs that they may not really need, or that may not be the best choices for them. Promoting little purple pills shoves aside the complex balancing of benefits, harms, and costs that should underly choice of therapeutic agents. For how many patients with dyspepsia or GERD will that little purple pill really work better than a generic H2-blocker or proton pump inhibitor?
What has made the current news about the Cox-2 inhibitors so troubling is that the drugs were advertised heavily as generally useful for arthritis, and all sorts of aches and pains. Thus, many patients for whom the drugs provided no particular advantage were exposed to their risks of adverse effects. Will the lessons learned from this episode lead to decreased, and/or more informative and realistic direct-to-consumer drug advertising?
The NY Times today reported the extent of vested interests in keeping such direct-to-consumer advertising going. Merck's spending on advertising Vioxx was $78 million a year. Pfizer was planning to spend more than $87.6 million on advertising Celebrex this year until it canceled the campaign. $3.8 million is now spent yearly on all direct-to-consumer drug advertising. This is not a trivial business for advertising agencies. Furthermore, $110 million, about one-third of the advertising revenue of the big three network evening news programs, comes from direct-to-consumer drug advertising. It remains to be seen whether such vested interests will resist down-sizing direct to consumer advertising, or at least making it more realistic and less like "marketing for Cheerios."


Egan Allen said...

I respect the free speech arguments re: drug advertising. It just seems ridiculous to advertise directly to consumers as per my previous posts.

However, the bottom line is that patients can't get these "products" without a provider's signature. We are the final link in the chain. I fear that we are a weak link as I have argued in the past (and in the face of testimonials from "strong-willed and pure" physicians that have resisted the dark-side of drug rep influence).

The prognosis is grim I believe. Most primary care physicians barely have enough time to go to the bathroom during the day (I am one) let alone review original articles in detail. I would argue that this leaves most PCPs to rely on review articles, drug-rep sponsored CME (including pharma-influenced grand rounds), abstract-only reading, drug rep sponsored dinners and other superficial sources (including drug detailing by reps) for their information.

The equation will not change for "our weak link" until cognitive physicians (i.e. non-procedure performing physicians) are adequately reimbursed to allow for LESS PATIENTS PER DAY to be seen. Too many patients means not enough time to stay adequately informed in my opinion.


Anonymous said...

How about "logo-ed" large faced wall clocks in drs'offices, plus memo pads, desk weights, pens, watches, etc., etc., and let's not forget "samples."

Anonymous said...

Commenter 1 is on to something!! As a statistician, I am perplexed by doctors complaining bitterly about DTC advertising as somehow "dumbing down" the drug selection process. Most doctors (well, to be precise, every doctor I have ever dealt with) really lack the ability to understand even basic experimental statistics. Why are their own views, therefore, about drugs worth automatic deferral? As commenter 1 points out, doctors are just as much "victims" to big pharma. as consumers.

Finally, what's the horror of having a patient ask for the "Super Dooper Humungous Erection Pill" when The generic humugous erection pill would do the job? If a patient really shouldn't take a pill, aren't doctors strong enough simply to say, as Nancy Reagen would urge them, "No." Again, in my experience, doctors are not exactly so customer satisfaction focused that such denial would be beyond them.