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Comment by e40 | Hacker News Reader

Patient goes in and "asks their doctor" about a drug.

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.

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Oh hell yes. The main one peaople ask me about right now is Marcumar/Warfarin, a drug many patients with atrial fibrillation have to take for the entire rest of their life, despite the fact that it has awful side effects and requires them to go to their doctor every two to four week to have a blood test done. Many patients are quite excited to hear that there's now new alternative drugs (NOAKs) that let you skip the biweekly blood draw. I get asked about Pradaxa, Eliquis and Xarelto so often, my standard Marcumar pitch now includes a whole paragraph about how those alternatives are just as bad. This is getting harder to sell as new studies are coming in and my arguments against the new drugs are steadily being reduced to "They're a lot more expensive." Patients really do NOT want to hear about how they have to get stuck with needles every two weeks so their doctor can save a few Euro a month in the prescription budget.

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.)

Slight OT: How much more expensive does the stuff have to be that biweekly doctor visits for blood tests are cheaper?

(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?")

Judging from their comments; that doctor lives in Germany, which seems to have a national health care system (in addition to private insurance).

(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.)

Several of the the thinner drugs cost $10-20 a pill or in the range of $5000 a year. Assume anything you see on TV is a mi imum of $300 a month, perhaps more. The roll-on testonerone is $500 a month. Bushes generous medicare drug bebefit maxes out at 90%. It can still break you with a couple big ones.

>Patients really do NOT want to hear about how they have to get stuck with needles every two weeks so their doctor can save a few Euro a month in the prescription budget.

This doesn't make much sense as an American.

> and requires them to go to their doctor every two to four week to have a blood test done.

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

As an ICU physician, I hate the NOAKs. The data may say that they bleed less. However, when they do bleed, I've got nothing that really reverses the bleeding.

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.

I will never stop being impressed at the breadth and depth of the HN audience. Thanks, you two, for your comments.

Most of these are for chronic conditions, where people are seeing their doctor on a fairly regular (once every few months) basis. And yeah, at least some patients absolutely do ask, "hey, I heard about X, is that good for me?"

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.

Well let's say you have a discussion with your doctor and they note there is a drug for your gastroparesis.

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.

In Denmark you are not allowed to advertise prescription drugs, so they will just advertise the illness and symptoms and end with a "ask your doctor about this illness".

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