Doctors want ban on prescription drug, device advertisements
arstechnica.com
arstechnica.com
They are the creepiest thing ever on television. The actors sit around dinner tables with family members speaking unnatural, FDA manipulated dialog ("Oh, I'm doing great, I've been taking Pradaxa for my afib, not caused by a heart valve problem!") Then you get the unending list of side effects read aloud ("death" almost always one) while the actors smile and stare off into space.
Occasionally, one of these ads will come in a 2 minute and 30 second variety that fills the entire commercial break.
A regulation I'd like to see is that all the side effects must be acted out in the commercial as they are read. Show the peacefully sleeping woman suddenly awakened, choking on her swelling tongue. Or a man running around with an actual 4+ hour erection.
"So I was listening to this one where it goes... Do you go to bed in the evening and wake up in the morning? And I went Oh my god! I totally got that! I should go see a doctor!"
Really couldn't have said it better myself.
INT. BEDROOM - NIGHT
FADE IN ON: Supremely apathetic insomnia-afflicted MAN fantasizing
about putting a revolver to his head.
NARRATOR (V.O.)
(speaking at breakneck pace)
Side effects may include suicidal thoughts...
CUT TO BLACK as gunshot is heard. MOONLIGHT SONATA begins to play.
SUPER: Prozac - Because you deserve to be happy.I could have never imagined
There is an argument to be made for consumer advertising for a drug like Viagra. Without awareness that an effective treatment exists, patients with ED or another embarrassing condition are not likely to bring it up with their doctor on their own, thus resulting in unnecessary suffering.
Another argument is that for various reasons some patients are unlikely to seek a second opinion, even when one is warranted. Consumer advertising is a way to present alternative treatment options to a patient whose doctor will not.
Also, I imagine that the cost of making and running the commercial would be pretty trivial compared to the profits to be made from the sale of the product.
Honestly though, it's a good system. I can't actually tell you what brand that ad is for, but I do know that I can talk to my doctor about it if I have issues with PE!
Your point is well-taken for individuals who don't fall in epidemiological categories (a 20-something is less likely to be asked about sexual dysfunction than a 60 year-old). Still, questions about sexual function are standard medical history questions.
Education about the availability of drugs can be performed by disease foundations - indeed, disease foundations underwrite the most risky part of drug discovery, the basic research component. For more common disorders, hospitals, the CDC, the NIH and even Google are beginning to provide digestible information that highlight standard treatments. In our web era, the importance of TV advertising for disease education is likely less than it might have been in the 80s.
EDIT: And another thing: you guys don't even have affordable health care, so people see this shit they blatantly can't afford advertised at them relentlessly. That's why spam is so lucrative I guess: huge demand built for something virtually no-one can afford.
That's not true, because most people do have insurance. The major problem is that the costs are socialized by insurance, so people buy excessive healthcare because then can afford it (they aren't paying).
There are other countries where everybody has insurance and the government negotiates medical prices. Japan, Germany, and France are three examples. They have much lower costs than the U.S. and the best health outcomes in the world, measured on criteria like death rates after diagnosis of major disease.
Source: Healing America by T.R. Reid.
And Japan, for example, has an aging population of heavy smokers.
Yes, this is the true culture of America. Blind acceptance and worship of capitalism.
Research has found that 80% of over the counter and 60% of prescription drug ads are misleading or false.[1] ED mediations are one of the top offenders in false advertising in the study.
1. http://www.scientificamerican.com/article/study-finds-most-d...
One of the repeat offenders, said Faerber, were erectile dysfunction drugs. “The various drug companies phrase it differently, but they all play on the idea of being “ready” when the moment is right,” but Faerber said readiness is about more than a physical reaction, it’s an emotional state – especially where sex is concerned. “They implied more than a physiological response.”
Really? They're all over YouTube and Hulu. They even come in a special widget with tiny text automatically scrolling on the right half and the ad playing in the left half. Just as uninformative and prosaic as the over-the-air spots.
As a non-American, currently living in America, these ads are the strangest thing I've seen on TV.
Most perfectly satarised in Robocop. Which looks, every year, more and more like it's being used as a road map.
These ads are also an important source of revenue for the networks. The TV stations are going to fight this as much as the drug companies will, if not more.
As you point to, some of these ads are long and long means expensive. I don't see how the networks won't fight this.
If it becomes illegal to advertise drugs to consumers, the interesting thing won't be what the drug companies does (they'll just target the doctors and save a ton of money). The interesting thing will be what TV will do to make up for lost revenue.
I think most of those rare side effects are not related to the drug at all. They just "happened" during the trials and they have to be included. At least in EU they are categorized by th frequency, so if the death is listed as 1 in 10000, I wouldn't consider it a side effect.
Further, it will be nice not to hear about an erection lasting over 4 hours, and not being too old for sex, in front of my 11 year old daughter while watching the news after dinner.
From a policy perspective, since the patients are not usually paying for the meds (you and I do), it makes sense to keep demand and prices low, as the doctors assert.
As for the free market, we do not have a free market in medicine. It is highly regulated through insurance and government regulation. So, I don't see a problem there.
"Any drug allergies?"
"Aspirin, Tylenol, Tramadol, etc"
"Oh, so you're allergic to 'all' non-narcotic pain medication? That must be ... inconvenient."
For me: I look at physiological symptoms. You tell me you're in 10/10 pain (the "worst of your life"/"worst you could imagine") and you're in no visible distress with normal vital signs, then I'll factor that into the decision.
That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body.
There used to be (probably still is) doctors in the ED who don't want a patient to come in with pain meds onboard because they want to see a "baseline presentation". Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane.
Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it's not "drug seeking" but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to 'give me the damn drug!").
No. There are plenty of other options for treating their pain without using opioids -- first I would educate them about the relative risks and benefits of, say, acetaminophen/APAP. I could use something like intravenous lidocaine or low-dose ketamine, or if it's a traumatic type of pain some kind of regional anesthesia. If it's more neuropathic, you can use tricyclics or drugs that work on GABA pathways. Beyond all that, I try to talk to people about the harms associated with opiates/oids such as hyperalgesia that develops in many long-term users, which is a really significant and underappreciated harm alongside things like addiction and potential respiratory depression.
Even worse, this further kills equality. A worker desiring to boost performance can easily afford top-notch medicines -- speed's only $20 a month for a starting dose at a pharmacy. But the prescription alone can be 10x that, and sometimes may be required every month. Not to mention the cost of a higher-end doctor that will assist customers. Poorer patients are thus denied medicine, creating a negative feedback loop.
this would introduce a myriad of acute public health issues and do great harm to the public good, costing taxpayers billions of dollars for remediation.
Edit: the DHHS's report on prescription medication abuse is good reading in this area: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_ab...
There are definitely more dangerous drugs than alcohol but legalization of all drugs isn't going to destroy society.
http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-con...
To claim that alcohol isn't regulated on usage or that most alcohol regulations are for taxation purposes only is pretty far off the mark.
The primary rationale for the taxation of alcohol itself is to counterbalance the public health issues that alcohol causes. Public health issues cost money to remediate.
Any chemicals? In any arrangement?
The guys in the park selling opiates at unspecified dosage and purity are available 24/7 and don't even ask questions.
This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing.
Additionally, this is a great backdoor way for consumers to be "educated" about conditions they didn't know they had. Consumers then would go to their doctor to talk about these things.
These advertisements are extremely effective at getting patients going to doctors about conditions they hadn't necessarily discussed with the doctor before.
Turns out, people suck at being intelligent healthcare consumers. Its not their fault though.
http://www.nytimes.com/2015/11/02/upshot/why-consumers-often...
http://www.nber.org/papers/w21160
Disclaimer: I am a strong advocate for single payer.
I encourage you to call your three closest hospitals, pick three surgical procedures, and ask them what the cash rate is from their chargemaster. You may get an answer from one hospital, possibly.
I'd agree that consumers would shop around given the proper incentives, and as long as those incentives didn't diminish the healthcare they receive (or their health in general).
Single payer seems to be the better option. It streamlines collecting revenue for the program, and the program is large enough that it can bargain or set pricing with healthcare providers.
Honestly, I think if we treated medical insurance more like we treated car insurance, home insurance, et al, then the cost of medical goods would go down.
As far as the specific price question, with respect to drugs I can easily get that information from my pharmacist, whether it is the cost difference between a name brand and generic or just the prospective cost of a medication.
- Months long waits for anything requiring a specialist unless you're literally about to die.
- Arbitrary exclusions like dental and optical.
- Doctors taking in ~50% of the entire provincial budget and whining that it's not enough.
And at a typical tech worker salary this all this ends up being more expensive in additional taxes than just buying the insurance outright would be in the US.
If you're not poor, there's really no reason to prefer single payer.
Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). Even if healthcare takes 50% of the budget, it's not all going to doctors, probably not even the majority of that. There are a lot of expenses other than doctors in a health system (nurses, administrators, buildings, equipment, materials, etc, etc, etc).
In the US, the big "single-payer" system, Medicare, is far more cost efficient than private insurance: http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef...
And I can think of at least one good reason to prefer single-payer if you are a not-poor tech worker: Job flexibility. Since insurance comes from the govt instead of the employer, employees don't jeopardize or destabilize their health coverage by switching employers or switching to being self employed.
Edit: wording
It's actually 42% in my province: http://wpmedia.news.nationalpost.com/2015/04/programexpenseb...
The average doctor makes $350k and the medical association is suing the government because they think it's too little (http://www.theglobeandmail.com/news/national/ontario-medical...).
It absolutely does not support your claim that doctors take in 50% (or even 42%) as it has already been pointed out that there are far more expenses in healthcare than simply doctors (e.g. drugs).
Drugs, like optical and dental, are not covered under health insurance in Ontario.
also people have an invisible waiting period in the form of not having the money to get things fixed so they put it off until it gets worse :^)
There's the whole "I am not poor but I have compassion for those who are and don't want them to die and suffer for lack of medical care" angle that you might want to consider.
FWIW, I asked my GP about this when I went in for a physical recently. He said he really doesn't get patients coming in asking for specific drugs in response to TV ads, and said he doesn't think it is an issue. Of course that's just one anecdote, but it shows that doctors are hardly in unanimous agreement on this.
I think most of these ads are targeted to people who are already taking a drug for a condition. They want people to ask their doctor to switch to their drug - something a doctor would have far less ethical issues with.
The problem of course is people switch away from a drug that has worked for 40 years to something new because of advertising and their insurance (and in turn, all of us) ends up picking up the cost for something that may have no benefit whatsoever to the patient.
Others are so brutally generic that they could apply to almost anyone: "Do you feel tired regularly? Have trouble getting going? Talk to your doctor about xxx".
Whilst I realize a lot of this is coded talk for "Do you suffer depression?" for people who might not have realized or be willing to acknowledge it as such, the sheer number of conditions for which "lethargy" is a symptom...
Also, nitpick, but the news and ads in general are almost certainly far more harmful (for your daughter; perhaps you, too) than hearing about ED meds.
"Surveys conducted by FDA and private organizations consistently show that DTC advertisements have an impact on whether consumers request and receive a specific brand-name prescription from their physician. [...] In several of these surveys, consumers were asked whether they had seen an advertisement for a prescription drug and whether seeing the advertisement resulted in discussing the medication with their doctor and receiving the prescription. Most consumers (65 to 85 percent) remembered seeing a DTC advertisement. A subset of consumers who saw an advertisement discussed the medication with their doctor. The percentage of patients asking their physicians about a prescription for a specific drug was consistent across studies, about 30 to 35 percent of those who remembered seeing a DTC advertisement. One study estimated that the 32 percent of consumers in a 2001 survey who had discussed a DTC advertisement with their doctor translated into approximately 61.1 million consumers asking about specific medications. In the consumer surveys we examined, the percentage of consumers who, in response to a DTC advertisement, requested and received a prescription from their physician for a drug they were not currently taking was generally about 5 percent (ranging from 2 percent to 10 percent). By our estimate, this means that about 8.5 million consumers received a prescription after viewing a DTC advertisement and asking their physician for the drug in 2000."
source: http://www.gao.gov/new.items/d03177.pdf
The data doesn't care whether or not you see the logic behind it.
This is true only if corporate executives are amoral automatons running hill-climbing algorithms. Rather than, say, citizens who use logic to make responsible decisions not just for their short-term profits but for the long-term good of their community.
Well, the system we have now really encourages that short-term, profit-finding behavior for corporations and the people who make decisions in them.
Many of the side-effects are just not part of the accounting, and therefore are not important to investors.
Money, money, money.
You say this as if there's no relevant data available. But again, if you can Google the actual answer, your 'opinion' doesn't matter.
This also explains why VISA and MasterCard advertise so much when you as a consumer simply take whatever the bank offers you.
You may need a prescription from a doctor to get a drug, but that doesn't mean you aren't the decision maker.
After finally getting a proper diagnosis for my condition, doctors began asking me "What typically works for you?" or "What drug do you like/is your preference?" I had a long history of health problems, thus lots of experience with what worked for me. After they gave me a proper diagnosis (and thus quit acting like dismissive assholes), I could walk into a doctor's office and say "I am having Yadda problem. I want (this list of meds) and am open to suggestions as to what else you think might help me." And get it.
Ultimately, I was the decision maker. The doctor's job was, in part, to inform me what my options were. But no one just crammed their medical opinion down my throat, even before I had a proper diagnosis and doctors were routinely being jerks to me and acting like I was some kind of hypochondriac.
Plenty of logic is there.
Part of the purpose is to make the Doctor pay attention to the advertising that they see in a journal. [1]
How?
Patient goes in and "asks their doctor" about a drug.
Then another patient. And another.
So now when the doctor sees an ad (or the detail man comes in) the doctor pays more attention and perks up. Similar I guess to the way once you buy a particular car model (or a friend buys one) you start to notice them all over the place. Same reason Pepsi puts ads in football stadiums. Builds general awareness and adds to reinforcement of the product as being "current".
HN works in a similar way for YC by the way. Repetition and current relevance very important in advertising.
[1] Edit: And of course Physicians also watch TV and read mainstream magazines and an ad is likely to stand out and get noticed just for that. (As a tech person imagine if you saw an ad for some software or SAAS that wasn't mainstream on the nightly news. It would certainly get your attention and stand out (more than if you saw it on Techmeme)).
I wonder if this really ever happens. I mean, for many of the ads, it's hard to tell even what the drug does, so going to your doctor and asking for that med would amount to a random question.
They might mention some names or might not.
You aren't ready so you basically don't ask for a script.
Later a week a month whatever there is an ad for Reglan on TV and you think "hey that was what the Doctor mentioned".
The ad is an ad, well done, so you in theory are now more receptive to taking the med. Especially since your symptoms haven't gotten any better. You are more willing to consider a solution to your problem.
So next appointment you ask more questions and walk away with the prescription.
There are of course also the extreme cases of specifically asking for a given prescription, but like the parent mentioned, just having a few patients persistently ask the doc about X is enough of a motivator to get the doctor to pay [marginally] more attention to the doctor-facing literature/ads/sales force.
The whole NOAK advertising scheme seems like a huge win for the pharma companies to me. (Possibly also for the patients. Not so much for the affordability of our medical system.)
(Not even getting into the topics of "how much is not having to do that every 2 weeks worth" and "can't the patient pay the difference if they want to?")
(In the US, a 15-minute doctor's visit could easily cost an end-patient $150-$200 out of pocket if their insurance doesn't cover it or has a high deductible; doing a blood draw every two weeks can get very expensive at that rate.)
This doesn't make much sense as an American.
Can't that be done digitally now?
http://www.thenorthernecho.co.uk/news/14030069.Warfarin_scre...
https://twitter.com/CDDFTNHS/status/666205891629359104
https://twitter.com/NHSIQ/status/666240577877499905
EDIT: Also http://www.nice.org.uk/guidance/ta249
Of course, novel reversal agents are coming and each one will likely only reverse one drug... and each one will cost an arm and a leg.
I understand why patients do it. I just don't like bleeding that I often can't directly control.
Plenty of us do.
The absence of a "free market" in this situation isn't merely a difference of driving economic theory, but of bodily sovereignty.
https://twitter.com/tsunderji/status/579053680919347200
Not sure if I'm missing some subtext though...
Or to pitch the influencers --- for example, grocery stores' putting sugary cereals on lower shelves, where kiddies can see them and ask mom and dad to buy them.
Patients will go to their doctor and ask about a specific medicine and too many doctors will give in to this pressure if they feel that the medicine will not outright harm the patient. Patient happy, doctor can move on to someone who deserves his/her care more.
You can't say that seeing that logo 500 times a day doesn't influence picking Crestor over, say generic Lipitor.
Pull marketing.
Same logic as for advertisements for children's toys, games and movies.
McDonalds advertise at children so they'll harrass their parents into buying crappy food. Drug companies advertise to encourage people to harrass their doctors for prescriptions.
Found your problem right here. The news no longer serves to inform. It's little more than a conduit for fear, terror, and doubt. Switch off the TV and go read some websites or books to find out what's happening in the world other than the latest development in a terrifying incident in which a handful of people out of nine billion died.
Better yet, take your daughter down to city hall or a county government meeting, and get involved with what is actually going to affect you tomorrow.
The information provided to both doctors and patients by drug companies is marketing material. The best source of information is peer-reviewed publications, and even those are subject to some bias. Still, that's the best source we have, and should be the primary way all of us get health care information. If you, as a patient, do not understand what the reasearch articles are about, bring them with you to your appointment.
In my clinic, I do not accept visits or items from drug reps (including glossy marketing materials, pens, etc); the only thing they can leave me is a copy of a peer-reviewed article.
The best way to tell which car is safer is to read the original cash-test reports. Furthermore, if you make a mistake in choosing your car, there is some chance you'll die as a result. Should we ban car commercial? Even car commercials that merely report (as they usually do) summaries of the crash-test reports ("best is class safety!", "4 stars from the car insurance safety board!"), because they may be biased in how they do so?
(I am putting aside opiate abuse, since illegal use is a different thing and opiates aren't advertised anyway. But this wouldn't much hurt my argument, since the deaths from cars are very comparable to opiate abuse, so one still can't argue that drugs are more dangerous than cars.)
But if you look at the data, you see that the deadliest vehicles are mostly compacts, and the safest ones are mostly SUVs.
http://www.thecarconnection.com/news/1096667_the-most-deadly...
These differences are huge, like, factor of 100 huge.
In the end, though, there's little doubt that the U.S. roads are the host of a vehicle size arms race - build in as many safety features as you like, a sub-compact car will still lose the inertia battle with a massive SUV (likely carrying a single passenger).
Still, the fourfold decrease in fatality rates across the ten model-years the IIHS publishes (coinciding with a substantial increase in the share of vehicle-years for 'mini' sized vehicles) completely discredits the "balance of mass" theory of car fatalities.
The stats that article links say that the 2011 mini cooper has driver fatality numbers that would have made it among the safest cars on the road in 2002. Eyeball regression says newer and pricier can explain essentially all of the safety differences, and vehicle size is at best a distant third.
As a doctor do you actually take time for questions? Can you be my doctor? Most of the time the doctors I visit are quick to write a 'scrip to treat symptoms instead of taking the time to find the root cause. After 10 years still no luck.
That's absolutely super good and I wished that more (all?) doctors followed your example.
However ... when I was unemployed, I was very happy that my doctor had free samples from her rep of $DRUG_THAT_KEEPS_ME_ALIVE. Our pediatrician also had free samples for some of the things our kid needed.
Just remember, public health care is communist! Better dead than red.
Thank you. This is the only rational approach.
BTW, the UK economy spends almost half in, relative terms, at 9.6% of the UK GDP vs the Americans spend of 17.9% of GDP, on healthcare. In real terms (2012 dollars), the UK spends $3480 per person vs the US spending $8362 per person. And we have a health care system free at the point of delivery.
And scooters: http://www.nhs.uk/conditions/social-care-and-support-guide/p...
And we subsidise cars for the disabled: http://www.motability.co.uk/cars-and-wavs/
1.) There is a very common assumptions in the USA that because a State funds healthcare, the individual is not allowed choice of doctor, which is incorrect in every public healthcare system I have used.
2.) That public or state run health care system is not substandard or less efficient to the American private system, but actually generally better for just about everyone.
3.) That if every American paid a flat 18% tax for healthcare (instead of any healthcare insurance premiums, whether paid directly by you, or by your employer), then the American government nationalised all American healthcare, every American should then receive at least a $4000 tax rebate. Then again your government could use that money fund better schools and universities.
[EDIT] And by-the-way, the UK Government still spends less than the American Government on every citizen, on healthcare. The American government spends $4437 per every single American citizen every year on healthcare. By contrast, the UK spends $2919 per person, every year. You tell me which tax payer is getting better value for money.
http://www.theguardian.com/news/datablog/2012/jun/30/healthc...
There are some very powerful, vested interests, namely the insurance and drug companies, that do not want public healthcare.
I am completely suspicious of private, for profit healthcare.
Are you seriously telling me that private healthcare is better? (Okay, private healthcare is better for the maybe the top 1% who can pay for their healthcare out of pocket, but if that is not you, the public system is better.) If I change employer, and therefore insurance policy and/or provider, I will never have to think about previous conditions that may not be covered with my new employer, for instance.
https://www.cms.gov/openpayments/
As a physician I can tell you that this type of public reporting has radically decreased the amount of stuff that doctors take from drug companies.
Removing advertising from the TV will do the same. It is much easier for a physician to give a patient the most correct medication without these biases. Remember that in the US, we spend about 2-3X as much as anybody else for less length and quality of life.
http://qz.com/553181/americans-spend-nearly-three-times-as-m...
IMO the real issue is that advertising (not just pharmaceutical) is not very informative anymore, we need a return to fact based ads. No more "sexy" women draped over whatever, no more saccharine smily women glowing after their husband took <y> ... Ads today are propaganda.
TV ads are not "information about medicines", that's just ridiculous. They are mind-games the advertisers play with potential customers in hope of squeezing more cash out of them.
You want true information? Read peer-review studies.
> Under the current model a doctor could say "You should take <x>" and I would have little to no exposure to alternatives
Right, 'cause doctors are evil like that. I just saw an ad revealing what doctors don't want me to know, I am totally going to believe it!
That we, as a society, allow people deceive us and to lie in our faces, and not only that - we've turned it into an respected occupation - still boggles my mind.
It is simply intractable. Like the halting problem.
[edit add: Because I actually don't disagree with anything you said, but the solution you propose never seems to work]
AFAIK systems hoping to discern truth eventually require a cannon.
I will agree though that the relationship between me and my doctor should be a two-way one. I am completely open with my doctor and make it known what i expect out of them, and they are the same with me.
The biggest issue with an outright ban is consumer education. Someone, something, or some organization needs to be responsible for properly communicating and educating consumers on a drug, its benefits, and its negatives. It needs to be educational, supplemental, and neutral.
Stuff like this does exist for cancer drugs but should spread to other drug areas as well.
Why shouldn't this just be their doctor?
To put it in programming terms, a front-end web developer would seek advice from a networking expert if her or his application was experiencing a lot of networking difficulties.
I don't think it's at all unreasonable to state that physicians are more than able to track all drugs relevant to their core patient populations.
But I don't know anything about this stuff, and I'd love for someone who does to teach me a thing or two.
Eg. If you have a plan with Blue Cross, they should have both software and individuals that can advise and be a resource to you. Maybe these are medical students, or some 2 year medical advocacy degree, RN, pharmacist - someone with some experience working/studying in the health care industry. So you go to the doctor and the doctor says, this is my diagnosis, here is a treatment plan, you call up your Health Care Advocate and they review with you as a second set of eyes on the issue. Maybe it all checks out, maybe there is a generic that could save you a ton of money, maybe there is a new drug that works better and your doctor was just going through the motions and isn't up to date on the drugs for your particular issue, but either way, having someone else there to help you get the best care would be a huge benefit, and thus a huge industry opportunity.
We call those people doctors.
> patients may want a drug that's not optimal for them (but I saw if on TV)
A doctor that ever caves to such a request is a terrible doctor.
As I am not residing in the US myself, the only experience I have of this phenomenon is in parody form: Progenitorivox!
https://www.youtube.com/watch?v=mYodDH4qZQo
(I may or may not have written this comment with the exclusive purpose of linking that video.)
Tylenol is the perfect example of this. Everyone "knows" that it reduces the risk of heart attacks, because of the marketing campaigns. But what most people don't know is how little of an impact Tylenol actually makes.
I've never heard a soul mention Tylenol in connection with decreased heart attack risk. Are you sure you aren't thinking about aspirin?
Do you mean Aspirin?[1]
[1] http://www.scq.ubc.ca/should-i-take-tylenol-advil-or-aspirin...
Wait what? Tylenol is acetaminophen, which is not associated with any heart benefit.
If anything long term use of paracetamol is possibly linked to a small increased risk of problems.
http://www.nhs.uk/news/2015/03March/Pages/Is-long-term-parac...
True, aspirin as a daily regime for people with no CVA/TIA (stroke) or cardiac history is of dubious efficacy, but worthwhile of consideration. It is however, certainly not going to alleviate chest discomfort indicative of an impending cardiac event (or prevent said event).
It's also a known blood thinner. Pro wrestlers take handfuls of the stuff before matches they're supposed to be bloodied in, then cut their foreheads open with a blade. The blood loss is superficial and controlled, but it makes for drama.
I'm all for this, but it's never going to happen without severe public outcry, and even then...
Amazingly that is untrue. Doctors have to know that it's the best drug and they often don't. Doctors are often creatures of habit. If I gave my last patient Crestor and it lowered their cholesterol, why not try the same with the next patient?
What you need is a clinical pharmacist not an advertisement. I am perhaps biased as my wife is a clinical pharmacist and one of her biggest things is to make the doctors use evidenced based practice rather than "this worked before" or "I saw this on TV".
The amazing part is despite actual studies (all readily available on pubmed etc) she gets ignored and the doctor does what he/she wants anyways. Some older male doctors (who perhaps lack some respect) will literally throw the printed out studies my wife brings to them in the trash.
That's 100% true for everything - just replace "drug" with "product". As soon as an advertisement is leaving the point of informing about product's existence and features, it's starting to trick people into chosing a suboptimal option.
In other words, a given advertisement might be tricking people into choosing the optimal option.
It could be so, in principle, but do you trust people who profit off not having your best interest in mind to do that?
I think disallowing "push" advertising while still allowing companies to make information available to patients who deliberately seek it out would be a good compromise.
While a layman can't be expected to fully understand the benefits/drawbacks/interactions of a drug in detail, it seems like it should be possible to have an easy to understand grid of positives, negatives, retail price, etc. that would make comparing say, the brand new bipolar drug to old generic lithium.
The end result of that would be that the gatekeeper to knowing about these drugs or devices are the doctor's themselves meaning those companies just have to work harder to advertise to the doctors to recommend their drug/device.
From Last Week Tonight w/ John Oliver: https://www.youtube.com/watch?v=YQZ2UeOTO3I
I just stopped turning on the TV in the end. These ads seemingly dominate television over there and some of the side effects for those drugs sound horrible, death is mentioned a lot.
I thought that practice was forbidden, but perhaps not: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811591/
TL/DR: Doctors like to prescribe new flashy drugs, and patient vs. doctor's ratings of various drugs are negatively correlated.
Even more specific metrics can be misleading. E.g. we know that cancer patients are more likely to be cured in the US than in Europe, but there's enough confounding factors to muddle any conclusions. It could be that earlier detection in the US leads to treatment for a cancer that would have gone into remission on its own and never been detected by doctors in another country. Or it could be that US cancer care is superior.
When I released it was the norm I wasn't surprised the US never established an NHS style system. Way too much money to be lost.
There are still sales reps in the UK, no?
(see also https://www.gov.uk/guidance/advertise-your-medicines )
Aren't drug ads, in a way, a good method for matching medicines to the people who need them? As far as I know, your family physician isn't going to call you when a new drug comes out that better treats your semi-rare, non-fatal condition - and patients aren't going to read medical journals to discover new drugs to ask their doctor about.
Family doctors are not likely to be treating a semi-rare condition.
To put it in programming terms, a front-end web developer would seek advice from a networking expert if her or his application was experiencing a lot of networking difficulties.
Further, even if your family physician is monitoring the progress of your disease, you'll likely also be seeing a specialist who will also be monitoring the progress of your disease.
Really?
I have family members with rare conditions - for example diverticul(it/os)is, which affects 0.74% of the population - and they don't see specialists. The family physician monitors it. And this is with a "Cadillac" insurance plan.
I don't think every rare condition automatically gets you in with a specialist.
Also consider that a family practitioner might easily have 2,000 patients. Thus, she or he will likely have direct experience with diverticulitis.
Further (and this is more inside baseball), your family members would need to be admitted to a hospital if their disease worsens to the point that a standard course of antibiotics won't help.
There might be better examples of 'rare' conditions than this, but the point stands - for any condition where extensive domain knowledge is required, you'll have a specialist involved.
Incidentally, diverticulitis is a very American disorder, likely attributable to our eating habits. You and all other readers should be sure to include fiber in your diet.
The family member in question has eaten a near total vegetarian diet for most of their life, so fiber intake is not the problem in this case.
let that sink in a bit.
from germany to japan to ghana to timor leste - everyone else has disagreed on this approach.
Only Uruguay has legal marijuana, doesn't make illegal marijuana a fantastic public policy.
Also I have seen recently the words, "these are not all the side effects, see our website for a complete list".
It's unbelievable what it has come to.
I don't understand your sentiment. Do you think that the drugs you take before do not have this many side effects, including suicidal thoughts or actions? Or do you find it unbelievable these side effects are now required to be spelt out in front of you?
Most of the drugs I see are ED/PE related and yes you can get prescriptions.
Still in the end, if we are going to allow untested by the FDA and others supplements to be advertised then why would we block drugs which have passed rigid testing from being advertised. Sorry, that would make zero sense.
This community sees the word "advertisement" and flips out. I guess health insurance and medical special interest groups did their homework on how to phrase the argument in their favor.
First, implicit in most of the comments here is the idea that whether you need or don't need a drug is a simple, black-and-white thing. The idea seems to be: if you truly had a need for a drug you'd be going to the doctor for it already, and if you were going to the doctor for it already you'd get the medication. It seems to me there's a lot more nuance. There are many, many classes of drugs that solve problems that aren't obviously "go to the doctor!" kinds of problems. I take a prescription medicine sometimes when I do public speaking. It never occurred to me to talk to a doctor about that problem, because it just seemed like a "problem" some people have and others don't. I happened to find out that this situation is easily treatable online, but I easily could have found out by watching a commercial. And this medicine makes my life significantly better, so that commercial would have been of enormous benefit to me, the consumer.
Secondly, it seems obvious that commercials which increase demand would inflate price. For the class of drugs like above -- drugs that make people's lives better but aren't saving lives or addressing significant medical problems -- why should that not be the case? I pay zero dollars for this drug because I have good benefits. Why should that be? I make plenty of money, and I can survive just fine without this drug. Why should I pay zero dollars for it? Why shouldn't the free market be in play in that situation? If we pretend my insurance didn't pay for this drug, I would be happy to pay a bunch of money for it -- or choose not to pay a bunch of money for it because it's too expensive. It's exactly the same decision I make about food at the store, or a new TV.
I understand that there are many prescription drugs that aren't "casual" in this way. I think it's good for society to do everything it can to grant to citizens a certain level of health, and therefore I'm all for restrictions on how these kinds of drugs are priced. And therefore it makes sense to have restrictions about how these kinds of drugs are advertised. But Viagra? Why shouldn't Viagra be subject to the free market? I'm an ultra-progressive (though rational) liberal here, so I don't really understand what I'm missing. Clue me in!
"May Cause Death." That's some good advertisin' right there.
Of course, it's interleaved with the ads from law firms trolling for the victims of the stuff advertised from five years ago...
I find these ADS very highly disturbing, and I'm old enough to remember times before these ADS too.
Banning things rarely makes things better.
Has it ever occurred to you don't have much control over that risk, and that you are a human being that like every other can become sick for no reason at all?
> and have family to help me out
Has it ever occurred to you that many people in the United States do not have family to help them out?
Has it ever occurred to you that many people in the United State don't have legs?
However, it damn well could be that I could get a disease or condition that no one can prevent. No one has any business pretending otherwise.
Let's fix that problem.
And? If that's their preference who are you (or I, etc.) to say otherwise?
Even the most staunch libertarian has to agree that personal choices which negatively effect society must have some sort of curtailing policy to make whole those effected
If the principle we live by is maximizing total individual freedom, then I think freedom from addiction has to be part of that.
For that matter, much of the point of advertising is also to subvert one's preferences. So as a believer in individual freedom, I'm in favor of ending corporate freedom to profitably manipulate individuals.
It's an interesting point to discuss. Presumably they did (in most scenarios) have a choice when beginning the drug, but then once addicted, you have a good point. So should we argue that that initial choice was made freely, and that we have no right to use force to break you from that addiction (presuming you aren't hurting or posing a threat to anybody else)? Or should we say that since you aren't truly making willful decisions, then intervening isn't violating your personal notion of agency, and going "against your will"?
I'd have to give this one some more thought to be honest. It strikes me that it isn't a simple question. OTOH, I still have no problem saying that anyone who is free to make conscious, willful decisions (whether we consider than rational or not) should be free to make the choice to put anything in their body that they want.
It's also important to consider that addiction is far more complicated than a dependance on a biochemical reactions to a stimulus. There are strong psychological issues at play as well. If we were to outlaw every addictive substance or action, surely no form of entertainment would remain legal.
A person always has a decision to engage an addiction. Deciding to not be addicted is the foundation to recovery. This choice cannot be removed at any point in a person's life, be it before, during, or after an addiction.
To say that an addict is not making decisions is like saying that someone you disagree with is not thinking. Just because you don't like their opinions or their behaviors does not justify denying their freedoms.
But overall, I am still for complete legalization of all drugs, as I still hold that a consenting adult has the right to put any substance in his/her body that he/she chooses.
I would also oppose a law restricting the advertising of prescription drugs. But, then again, in my world, the distinction between "prescription" or not would be a lot fuzzier anyway. It might even disappear altogether.
For example, I think people should be free to play all they want with explosives. But given that explosives are subtle and dangerous, I think it's reasonable to require that people using them be licensed, including extensive practical exams, and that they be properly insured, which may include insurance company inspections and the like. They're welcome to make the choice to light any given fuse, but given the potential consequences it should be an informed, responsible choice that has fully accounted for the consequences.
Even if that were true, I don't see how overriding personal choice is the correct move.
A patient will never be able to make a rational decision when buying a drug. So the market economy clearly breaks down if you ever consider patients to be the customers.
Nonsense.
Britain for instance allows over the counter medicine that's illegal in the US.
Is there some mass irrationality going on over there?
Most of the time yes, but this is about creating a functioning market. I don't think people can be trusted to create a functioning market for products they sometimes can't set a monetary value on (if they are ill) and sometimes don't understand (because they aren't doctors).
> Britain for instance allows over the counter medicine that's illegal in the US.
I'd guess there is medicine that is allowed over the counter in the US that would be prescription in the US. But the bulk is probably the same.
I fail to see how not being able to tell my doctor he should provide me with a specific prescription medication is detrimental to how I run my life.
Healthcare costs need to be held down, most importantly in single payer systems, but it's quite important in insurance based systems too.
"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" - Upton Sinclair
Where did you get this idea from?
> Over and over people on HN come to the defense of advertising.
This was based on an outdated[1][2] understanding and personal experience (my father is a physician and nearly every physician I knew supported Reagan). I retract.
> Over and over people on HN come to the defense of advertising.
I know this because in my comments here I frequently criticize the role of advertising on the internet and society in general. The downvotes are many. Not everyone defends ads, but many do, and my comment is directed at them.
Here's one thread[3]. I can't spend more time on this, so if you guys still don't believe me, you win (for the moment). I'd rather you were right anyway. -
[1] "In the mid-90s, 72% physicians' campaign donations went to Republicans." https://www.advisory.com/daily-briefing/2015/04/30/how-docto...
[2] "The percentage of contributions that doctors have given to Republicans has mostly declined since 1996. It dipped below 50 percent in 2008 before rebounding in 2010." "The study attributed the partisan shift to an increase in female physicians and the shrinking number of doctors running their own solo and small practices." http://www.nytimes.com/2014/06/03/upshot/doctors-arent-stron...
Reminds me of a pretty interesting post by Yvain[0]. The relevant quote:
"There are certain theories of dark matter where it barely interacts with the regular world at all, such that we could have a dark matter planet exactly co-incident with Earth and never know. Maybe dark matter people are walking all around us and through us, maybe my house is in the Times Square of a great dark matter city, maybe a few meters away from me a dark matter blogger is writing on his dark matter computer about how weird it would be if there was a light matter person he couldn’t see right next to him.
This is sort of how I feel about conservatives.
(...)
What I mean is – well, take creationists. According to Gallup polls, about 46% of Americans are creationists. Not just in the sense of believing God helped guide evolution. I mean they think evolution is a vile atheist lie and God created humans exactly as they exist right now. That’s half the country.
And I don’t have a single one of those people in my social circle. (...)
I live in a Republican congressional district in a state with a Republican governor. The conservatives are definitely out there. They drive on the same roads as I do, live in the same neighborhoods. But they might as well be made of dark matter. I never meet them."
--
> Here's one thread. I can't spend more time on this, so if you guys still don't believe me, you win (for the moment). I'd rather you were right anyway.
Hah. An advertising-bashing thread I missed :<. I post a lot of negative comments about advertising too, and the reactions are... mixed. I have an impression that HN is a bit split on the issue, some believing that it's absolutely necessary and others (like me) who would say "good riddance" if all ad-supported web sites disappeared right now. But I don't feel like there's a HN consensus around ads.
[0] - http://slatestarcodex.com/2014/09/30/i-can-tolerate-anything...
I'm writing a treatise on advertising and the internet, or at least I'm trying. I might hit you up for feedback. It may be a while.
I find myself repeating so often, and being asked the same questions so often, that I decided to write down and maintain a description of my current beliefs on most frequent topics - to serve both as a FAQ for someone asking and as a collection of points and citations to quote.
I'm in the process of writing stuff down, but I still haven't figured out what would be the best way to publicize it. I'd like something that would show the current state of article, but would also allow to easily view the changes over time (as my beliefs get updated based on evidence). Sort of like more streamlined Wiki, or Wiki meets Github meets Etherpad or sth.