More On DTC Ads

Chris Rangel joins the choir of physicians asking the federal government to give them back the keys to their gate:

Even though I have been an advocate of free markets in the business of health care, I have not thought that direct to consumer advertising (DTC) is such a good idea. In my opinion, DTC of prescription medical products is inherently problematic. It is way too easy for these ads to be misleading and quite often they are.

...But believing that consumers/patients are perfectly capable of making informed decisions based on drug ads does not mean that this is true. This subject is poorly studied but while there is no data that drug advertising helps patients make better decisions there is evidence that DTC adversely affects drug utilization. The sales numbers of Celebrex and Vioxx are perfect examples of this.

Which reminded me of this nugget from Jerome Kassirer (former editor of The New England Journal of Medicine) in last week's Houston Chronicle:

Q: Is this direct marketing of drugs to patients helpful or harmful to good medicine?

A: Overall, I think it's a big negative. It encourages people to ask for drugs that are the newest and most expensive. But they're not always the best. It also puts pressure on doctors to order those drugs when sometimes it is not in the patient's best interest. My guess is that this trend toward direct marketing to patients will only increase.

Followed closely by this:

My first advice is that patients need to be far more involved in their own medical care. You wouldn't buy a new car or a washing machine without knowing a lot about it. But people have taken the tack of simply allowing their doctor to call the shots. I think that's a big mistake. There are so many good sources of medical information that are unbiased, like government Web sites, and I really think patients should understand their disease. Secondly, patients need to be aware of circumstances in which their doctor could be making choices that are in the best interest of the doctor and not the patient. They should be asking a lot of questions.

First, ignore the wonderful part about the government being the source of unbiased information. That one's just too rich - I'll let someone else have a shot at that. No, I'm more concerned about someone who thinks DTC ads are bad but then says patients should have more control over their care. Which is it, doctor? Should patients become more informed, or should they become more informed only with the information you think they should have? And if the latter, how is that really gaining more control? And who should be the gatekeepers of that information, if not doctors? I'll leave it to the author of CodeBlueBlog to say what I've said many times before:

There's PLENTY of useful information in the drug DTC ads I see, and you know what, most of those drugs are FANTASTIC and the commercials are no more hype or deceiving than any other commercials (probably less so), and consumers are pretty well aware of what the advertising game is all about. I don't think we have to protect them.

I find the viewpoint that consumers need to be "protected" from DTC advertising profoundly cynical and paternalistic; people are capable of figuring out what is hype and what isn't; and when they can't figure it out they ask questions and employ services to help them. Those services in turn generate business and information. The information educates. The whole process is educative.

...It is my belief that much of the agony we deal with today, as physicians, in regards to this "health care crisis" is due to ignorance we have bred into the consumers. First, for decades physicians adopted a Brahmin-like dissociation from their patients that dissuaded questioning and consumer involvement in care -- and that backfired big time on us; Second, the system of third-party payers has completely suppressed any motivation for health care consumers to understand or respond to differences in choice, quantity, quality and risk assessment. This too hurts us severely.

...The answer is almost never LESS information. That's why the blogosphere is exploding. People want more information, and they are capable of sorting through it. Even if it's on the back of a cereal box.

Share this

Exactly. Humans are very

Exactly. Humans are very smart creatures. We can figure many things out, especially when private enterprise realizes it must present information about products simply.

The problem in medicine is that doctors built a medical gate and now they have the key to it. You know, a car is a terribly complex thing too. I doubt very many physicians could put their mercedes together from scratch, or tell me exactly how quantum mechanics and string theory affect the trajectory of the satellite communication for the Onstar system. But, since car companies willingly compete for their customers, no one has to know these things to ride in a 'benz or think Onstar is cool. A 30 second commericial communicates the necessary info just fine, and the automobile industry out performs the healthcare industry in customer satisfaction, quality control, and efficiency hands down!

PS...if you really wanna get riled up about medical gate-keeping, tell me what you think of the new Narrative Medicine movement at Columbia medical school.



"It encourages people to ask

"It encourages people to ask for drugs that are the newest and most expensive. But they’re not always the best. It also puts pressure on doctors to order those drugs when sometimes it is not in the patient’s best interest."

I suspect that when a patient asks "What about this medicine I see ads for on TV?", doctors are more likely to just give them a prescription for it than to actually both taking the time to talk about it. The question was a request for information, but the doctors seem to interpret it as a "demand" for that particular drug. I think most patients would prefer doctors to spend more time talking to them instead of just writing a prescription immediately. It is not that the ads are so powerful, it is that the doctors are such pushovers.