The harm caused by any given medical advertisement is directly proportional to its effectiveness. Every pharmaceutical sales rep is an immoral cancer on our society.
Make all drugs legal, but mandate they have boring text/information-only labels, put the more dangerous ones behind the counter in smaller quantities, and let the only thing influencing their purchase be doctor recommendations/prescriptions or personal research. It should apply evenly from ibuprofen to allergy pills to marijuana to cocaine to alcohol.
It's interesting how molecules can be considered 'food', 'medicine' or 'poison' in different contexts.
Do you prefer Instagram "influencers" to have more control over what drugs people take than the current regulated advertising? I don't.
https://en.wikipedia.org/wiki/Direct-to-consumer_advertising
The US and New Zealand are the only countries where direct-to-consumer advertising is legal.
This is already the case in many places outside the USA (Canada, Europe, Brazil, Hong Kong).
https://en.wikipedia.org/wiki/Direct-to-consumer_advertising
USA, New Zealand.
That's it.
The advertising amount and impact in NZ is a lot lower than in the US as our healthcare system is largely public (government funded) with a single buyer (Pharmac) of pharmaceuticals that exercises considerable pricing power, and is unafraid to change brands. Most of us go to the doctor and take what is prescribed.
https://www.asa.co.nz/codes/codes/therapeutic-and-health-adv...
For example, I loath that they advertise paracetamol (acetaminophen) as "better for the stomach" directly targeting Aspirin and other NSAIDS. No mention of how many peoples livers get permanently fucked by paracetamol.
Unfortunately the advertising propaganda is successful, and people avoid safe drugs that have side effects that can be managed. Evil.
If you're diagnosed with a medical condition or have a specific ailment, then you can investigate potential treatments.
The status quo "compromise" solution gets this exactly backwards. "This drug will make your life better. So ask your doctor so they'll comb through your medical records and history looking for something kind of like what we claim to treat[1], so they can prescribe our drug for you." Lies and failure to mention side effects are not the only problem with advertising. The problem with advertising is that it seeks to persuade people, using every trick in the book short of actionable lies and omissions, to buy drugs that even doctors can't properly evaluate because drug research is pathologically flawed. And those advertising tricks are effective at getting people to buy drugs which they don't need and which will do harm, because most drugs do some kind of measurable harm whether it's potential liver or kidney damage or increased risk of dementia or cardiovascular problems or cancer or whatever.
Pharma companies that seek to extract rent from your "conditions" are the last entities you want telling you what you might have, and they're the least trustworthy entities to be allowed to get you thinking that their drug might be your best option for treating your "condition" because you heard about theirs first and they made sure their advertisement stuck a bunch of positive associations to it in your mind.
"Ask your doctor about our drug instead of asking for advice on whether other things, including exercise, eating better, and getting better sleep might help, because those take time and effort and you have no time and no willpower except when you're dancing in a field of flowers like we showed you doing when our drugs solve all your problems so you should pay us rent for life for your 'medical condition'."
[1] Have you noticed most drug advertisements don't even claim to treat anything specific, or are intentionally vague? The charitable explanation is that the condition is often something taboo or embarrassing, but I think a bigger part of the reason is that pharma doesn't want you losing interest in the drug before you ask your doctor about it.
I know at least a few people who didn't realize they had an ailment until seeing the symptoms listed on an ad. There is a balance between promoting new drugs (and the affiliated afflictions) to the general public and pushing medicines to doctors.
We're that fixed you would learn about conditions you didn't know you had from the doctor. Or therapist.
BTW, it’s actually pretty common in many US states for pharmacists to be required by law to fill prescriptions with their generic equivalents.
Legit palsey is a completely different story.
This seems like one of the most cleanly horizontally divided opinions in all of the US - where nearly everybody agrees loudly and strongly with it except the wealthy and powerful. I wish a presidential candidate would have the balls to echo this severe but obviously popular thought and fix the fucking system with extreme prejudice.
And because big pharma seems to always win.
Pharma gets what they pay for. Vote for someone who isn't beholden to them.
Hell, because of the Electoral College, my vote ultimately doesn't count if it isn't what the whole state picks.
Hilary had some uncomfortable ties to Wall Street -- she was a Senator from NY, mind you -- and the DNC chair Debbie Wasserman-Schultz picked up a lot of Budweiser money by scrapping any DNC talk of Marijuana Legalization (DWS has long battle MJ Legalization in Florida, so she's been taking their money for a while, or was a sympathetic bribe for Alcohol). But I could have lived with that in exchange for working health care and sane foreign policy.
[1] see also: the russian firehose of propaganda -- https://www.rand.org/pubs/perspectives/PE198.html
Doctors as decision makers are not some monolithic block of individuals who are super educated about every product on the market and every piece of data. Just developing awareness of new drugs is a huge job. I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs.
The best story I can tell was from a friend who worked at a drug company that sold a hepatitis C drug. Once Gilead's drug came out, this company basically decided to discontinue their drug. Incredibly, there were doctors out there still ordering the old drug. The company had to send reps out to these doctors to tell them to stop ordering it. Continuing to use it made zero sense at all.
Really? You don't see the difference between marketing, say, a car or a smartphone, and marketing a drug that treats a life-threatening condition?
Perhaps you should think about this subject a bit more deeply.
>> I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs.
What do you base this on? Do you have some citations to support it?
Chronic pain (and a whole host of other issues) aren't life threatening. Until the mid 20th century people just lived with chronic pain and tons of other things. Look at the kinds of TV ads you see, they're for drugs that minimize the symptoms of some some negative, but not life threatening thing. These are not essential products. They're luxuries of modern life that we consider to be nearly essential. Depending on one's specific situation having a smartphone or car may actually be more "essential" to daily life than having one's condition treated.
As an aside, drugs that actually save lives don't seem to get marketed much.
As an aside, it's insulting to preface a rebuttal with, "this may come as a shock to you".
Some resources:
[1] https://www.sciencedaily.com/releases/2018/05/180514132441.h...
[2] https://www.pewtrusts.org/en/research-and-analysis/fact-shee...
Plus, this classic Scrubs clip describing a particularly chauvinistic (but truth-in-television) take on the practice: https://www.youtube.com/watch?v=VMXa0U4WZyU
And there is plenty of research demonstrating that this is exactly what they do, and that doctors are indeed swayed by it, because, as you say, they don't have the time to do keep up with it all on their own.
And yes, there is a fundamental difference to consider here: My doctor has a fiduciary responsibility to do what's best for my health, to the best of their ability, and drug marketing compromises that. By contrast, nobody has any fiduciary responsibilities related to which brand of toilet paper I use.
There will be those that don’t change their practice ever once they graduate (seen a few).
Things get more complex when you have dozens of treatments for a condition with no clear winner.
Before I got in the industry I thought “what the hell does marketing do?”. Then once I saw what they do, I realized, no, most drugs don’t sell themselves, there is too much inertia for doing the same old thing.
If you develop yet another blood pressure drug or cholesterol drug and want GPs to prescribe it, you're going to have an uphill battle.
A blockbuster drug for HepC (where treatments before weren't particularly effective and had ugly side effects) will have a much easier time becoming well known amongst the specialists that treat the disease.
The government isn’t going to get away with hiring entire teams based on looks and then have a marketing line item for free fancy lunches for people that are definitely not starving.
Choosing Wisely is a broad approach that is somewhat like you described.
Other things that exist to counter this bias are competitors, who will provide a different perspective and most importantly, the FDA that regulates all pharmaceutical promotion for accuracy and will quite swiftly drop the hammer on a company that bends the rules.[1]
[1]https://www.fda.gov/drugs/warning-letters-and-notice-violati...
Then you bundle all that up with the various studies that show that doctors(as with all professions) do a poor job with continuing education so that they are further inclined to take the recommendation from the pharma reps(which can be seen in the roots of the opioid crisis), I don't think we're in a very good place from a regulatory standpoint.
[1]http://phrma-docs.phrma.org/sites/default/files/pdf/phrma_ma...
If memory serves me right, the theory is that it makes you overestimate your ability to stay objective and unaffected, so you're effectively lowering your guard, or something along those lines.
The job of the marketing department isn't "best drug for patient". That's the doctor's duty. The marketing department is there to bring awareness of the product to both doctor and patient. There is no conflict of interest at all.
That's how it is, in practice.
But some of us take that Hippocratic Oath thing seriously.
I often ask foreign expats in America about the strangest aspect of American culture in their opinion. Believe it or not, pharmaceutical advertising is one of the most common answers I get.
A lot of marketing does not seem very educational and more manipulative.
Most advertising is more about triggering emotions and using other cognitive dark patterns than educating anyone.
Look at car ads. Do they say "The new 2019 models are available"? A few do. Do they say "This car gets better gas mileage" or "This car is safer"? A few do. Most say "If you drive this car, you'll get the hot girl". That's not "educating consumers". That's trying to make consumers want your product on the basis of something completely unrelated to your product.
And yes, I fear that marketing pharmaceuticals may in fact not be different from marketing any other product.
A few of the negative findings:
-Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.
-In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.
And positive findings:
-Many physicians thought that DTC ads made their patients more involved in their health care.
-Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.
-The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.
[1]https://www.fda.gov/drugs/drug-information-consumers/impact-...
You and I must be watching different commercials, because I see far more of the former.
I think it's changed a lot since the 60s and 70s. Cars are seen as more utilitarian now, and younger people don't even care about getting their license, let alone being concerned with "what you drive".
The introduction is the most juicy bit as the particular article I found is about intra-sex competition but states a few interesting studies in their introduction about being desirable to women.
In short what I skimmed so far related to this idea is:
"And indeed, a man who was seated in a luxury car was perceived as more attractive by women compared to the same man seated in a nonluxury car (Dunn & Searle, 2010). Hence, men appear to use showy spending to attract women in intersexual competition contexts. Sundie et al. (2011) further revealed that men’s flaunting of luxury goods signals their desirability as a shortterm (rather than long-term) mate."
Personally, I don't car about any of this. However, academically (from an evolutionary psych. view, lol): yes, men are seen as a more desirable mate!
If this conclusion is also actually true (and not subject to whatever ails the field of psychology) then I'd chalk it up to most of humanity being vain and if you want to get vain people you need to be the vainest of them all and get the sports car, the fancy house, other desirable 'high value' women in pictures and all that jazz. Though, why not just immediately go for the private helipad and private jet with built-in Jacuzzi? Nothing attracts as much as offering young people in general a trip around the world in pure luxury! Or so I presume. So don't buy the sports car. Buy the helipad with helicopter on top.
Source
Title: What If the Rival Drives a Porsche? Luxury Car Spending as a Costly Signal in Male Intrasexual Competition
DOI: 10.1177/1474704916678217
URL: https://journals.sagepub.com/doi/pdf/10.1177/147470491667821...
Surprised the PC Police haven't demolished you for pointing out that, on average, women are attracted to men who convey wealth (even though it's blatantly obvious).
I said:
> Personally, I don't car (sic! also no pun intended) about any of this. However, academically (from an evolutionary psych. view, lol): yes, men are seen as a more desirable mate!
So first, I see evolutionary psychology as a joke and I don't care about the research because I think it's all lies anyway. I'm a bitter man when it comes to the promises of psychology being truthful about how humans think (the field has too many issues).
Secondly, I simply quoted research. And remember from point 1, distanced myself from that opinion.
Thirdly, in my experience I never needed to flaunt my wealth in order to attract women. I think the same is true for most if not all of my friends (both sexes). Disclaimer: I'm Dutch (maybe culture is a thing).
I do agree with you that pharmaceutical marketing isn’t fundamentally different from marketing other products. Although my conclusion from that is not that pharmaceutical marketing is therefore good.
Personal and non-personal promotion is how it’s done in Europe.
Well no not at all. Innovation is both the process itself + the supporting requirements necessary to make it work on a massive scale. We cannot minimize the cost of investment in making sure treatments are effective and non-harmfulu in the general population. That is a critical part of medical innovation.
That’s like saying Apple didn’t invent the iPhone because Shockley discovered transistors.
Doctors/hospitals can learn about new drugs through dry, informative leaflets - TV ads or salesmen talking directly to doctors distorts the demand.
There is moral validity to profit-seeking investment in drug trials which find effective treatments, but the current system enables this only with great amounts of inefficiency.
agree
>Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize).
Can you elucidate the connection to your first statement - I don't see how that follows.
For-profit Pharma companies have a fiduciary obligation to only invest in research which they can profit from. This leads them to only invest in research in the tiny proportion of "interesting drug candidates" that can be monopolized.
Ex. - Imagine scientists find that saffron can be an effective antidepressant with few side effects. They research the active molecule and find that adding a bromine atom would make the molecule patentable, but it is slightly less effective and has more side effects. The drug company has an incentive to spend great amounts developing the less-effective patentable drug, and no incentive to research the other. Drug company has incentive to try to convince the public that their inferior molecule is actually preferable.
Now, we have a lot of data about the safety of saffron - people have included in their diets for hundreds or thousands of years. If this can be used to treat depression, it will likely have a much better safety profile than a novel molecule which has never been ingested by humans before. The therapeutic index of saffron (delta between effective dose and aversive side effect dose) is huge! Likelihood of getting it through safety trials has very high bayesian prior.
(Saffron as antidepressant is an area of recent research - all papers I've seen published by academics https://scholar.google.com/scholar?hl=en&q=saffron+antidepre..., I made up the bromine part for the example. Saffron may also be useful as anti-tumor and in ADHD treatment)
Pharma Co's may be investing intensely in researching a tiny fraction of drugs, but this fraction is less likely to contain the safest candidates and thus I don't think those dollars are being spent very effectively.
Investing in a tiny market and low prices means that investment is gone and won’t support future R&D.
Well, there's disease, death, suffering and injury. If you need more of a structured incentive than that, then I am not sure really what to suggest.
we're gonna pay for the drugs either way, so we may as well create our own incentive structures to ensure that it's done right.
What the current system gives us isn't "R&D and innovation". It's mostly ~equivalents of top-selling products. Plus new stuff that's actually less effective than old products that went generic so long ago that there's ~no promotion.
It's important to realize that to a first approximation, advertising prescription drugs is pure waste. The main case is pharma companies battling for fixed market share. That is, there are N people who have the problem, and companies X, Y, and Z are spending money trying to maximize their share of the market. The ad spend changes which pharma company does the best, but that money comes from the sick people, who would be better off without it.
The other case for advertising is demand generation, and for drugs I think it's mostly waste as well. I definitely know a couple people who are not sick enough to really need drugs (or perhaps not sick at all), but advertising-induced hypochondria means they badger their doctor until they get a prescription. That's an expensive boondoggle.
I'm sure there are some people who hear an ad and realize they have an actual problem. But if that's a significant issue, I'd rather we just paid for public service announcements for disease awareness, rather than hoping the very profitable drugs are the same ones people have the biggest medical need for.
And theory aside, advertising prescription drugs to the public was illegal for decades and we still did fine on the medical innovation front.
It’s inaccurate to suggest that’s the only market for drugs.
How can we prove that this is false or that the benefits are smaller than the drawbacks?
Find a natural experiment where two very similar populations, chosen at random, were placed into two different cohorts. I'm sure there's one somewhere in the recent and well documented past.
People need agency in their own medical choices, and knowing there is a drug for your medical condition is very empowering. Especially as we talk more and more about moving to a single-payer system, it's important to make sure patients have the power to question their doctors and explore their own health instead of essentially being dictated to by the state.
Of course the problem is the reliability of the evidence. I recently had to decide whether I wanted to go on a course of some fairly severe drugs with nasty side effects.
The original papers didn't make a lot of sense. The statistical conclusions seemed to be - if not nonsense, then certainly not very consistent.
My doctor said "Well, these are new drugs, so we're still learning about them." I didn't find that reassuring.
The real problem is that big statistical studies don't say much about why side effects happen. There seems to have been far too little research into understanding why/how side effects happen at all, and whether or not it's possible to screen for them.
That would probably require a level of personalised medical screening and dose control that big pharma isn't interested in providing.
There's no way the only possible method of resulting in having informed patients is to put them directly in the middle of a struggle between big companies and doctors. I'd argue that putting doctors in a position of power is terrible (whether single-payer or not), but giving pharma companies' marketing departments the freedom to manipulate people with advertising is also terrible. Two wrongs do not make a right - adversarial systems are poor designs.
A patient that walks into a doctor's office asking for a certain medicine they heard about on TV distorts the process. After all the patient needs to believe in the treatment and might shop around for the doctor that gives them what they want.
Learning about a product in a medical context can't really happen in an ad. A doctor would have to go to a conference or read journals to figure out the latest science on treatments, and can then go and then choose an appropriate drug. They would probably look for the one that has 20mg of X in it, regardless of brand name or hype.
This is far to simplistic. It's fairly common for doctors to be unaware or poorly informed on new or uncommon treatments. They have a finite amount of time and brainpower and are not all knowing.
or possibly just delivering takeout to them at the hospital so they can relax and research new treatments while eating.
(seriously, drug companies give doctors free takeout)
Yeah, there seems to be this contradiction here that doctors are naive or corrupt and are going to be swayed into prescribing us drugs we don't need, but also that we should be leaving it 100% up to doctors to be informed and prescribe us what we need.
- Supply your molecule for free to all researchers without any strings attached.
- Maintain an inclusive directory of research people have performed with your molecule. Publish a journal of all research and redistribute it for free.
- Commission impartial fact sheets that are surveys of treatments for a given condition - what objective measures of outcomes can be made between treatments, both positive and negative?
Every time I hear “Ask your doctor about ____” I cringe. How is this ok?
Your final sentence isn't conveying any objective information -- in fact, it seems pretty close to emotional propaganda itself. Does that make you an immoral cancer on our society? (No.)