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Every time I am visiting USA, I am flabbergasted at the medication ads on TV. Not just for off-the-counter stuff like paracetamol or anti-inflammation medication but actual freaking prescription only drugs.

And they actually ask you to speak to your doctor about the drug. Haha what? Shouldn't my doctor morally and by default be suggesting the best treatment for what I have? And if I don't trust his/her treatment plan then why not switch to a different doctor?

Playing devil's advocate... doctors are neither omniscient nor perfect.

> Shouldn't my doctor morally and by default be suggesting the best treatment for what I have?

Shouldn't programmers by default be suggesting the best algorithm/programming language/design patterns for the problem at hand? In a perfect world, yes. But we live in an imperfect world where sub-optimal choices are made due to time constraints, lack of knowledge/experience, etc. Doctors are not exempt from this same phenomenon, in fact it may be amplified because there's just so much more knowledge you need to index and access compared to programming. Just as you don't know about every web framework in existence, doctors don't know about every medicine in existence.

"Ask your web designer to see if using Svelte is right for you."

> Shouldn't programmers by default be suggesting the best algorithm/programming language/design patterns for the problem at hand? In a perfect world, yes. But we live in an imperfect world where sub-optimal choices are made due to time constraints, lack of knowledge/experience, etc.

I don't understand. Are you saying you frequently have non-technical customers of your software business asking for specific languages, design patterns and frameworks which end up being the optimal choices? In my personal experience this has never been the case. Also somehow I feel like it would be even worse if they heard about them from TV instead of from a generic blog post somewhere.

Do the vendors of these languages, design patterns and frameworks have billions of dollars riding on your choice? If so, you'd better believe your non-technical customers would be seeing ads pushing them to advocate for one over another. The more non-technical the better, because technical deficiencies become less of a barrier. You already see this today with products pitched at the bosses rather than the underlings that are getting the work done.

Agreed. I think the point is that this is bad, and that if “patients asking their doctors to prescribe particular drugs” is an analogous situation, then it too is bad.

I wasn't arguing that those things aren't pushed, but rather that they're rarely pushed with technical merit. See: "...which end up being the optimal choices?"

This happens all the time with "buzzword trends" more so than specific languages/frameworks. Does your product have "big data / AI / ML / IoT / blockchain" etc ...

>Playing devil's advocate... doctors are neither omniscient nor perfect.

There's been some research into this subject, and, in this case, it would seem that you are indeed advocating for the devil. I haven't read any of the papers myself, but the stories I've heard via channels such as the Science-Based Medicine blog or PusCast suggest that drug advertising - both to doctors and direct to consumers - tends to result in both higher health care costs and poorer patient outcomes, because it increases the odds that a doctor will prescribe a more expensive and less safe or less effective (or at least no more safe or effective) drug.

It's supposedly down to the drug companies' incentive structures. Once a patent expires, they often start tweaking the molecule to come out with new drugs that behave similarly, but are chemically different enough to qualify for a new patent. They then sink a lot of money into trying to convince doctors to prescribe it instead. Their avenue for doing this is advertising, which doesn't have to clear nearly as high an evidentiary bar as any of the scientific channels for disseminating information.

>>shouldn't my doctor morally and by default be suggesting the best treatment for what I have?

>Shouldn't programmers by default be suggesting the best algorithm/programming language/design patterns for the problem at hand?

Are you implying non technical users would somehow be able to make a crucial technical design decision because they saw an ad somewhere? That seems quite absurd.

In my professional experience, every time a non technical stakeholder has tried to force a specific technology to solve a complex problem, it has been disastrous.

> Are you implying non technical users would somehow be able to make a crucial technical design decision because they saw an ad somewhere? ... In my professional experience, every time a non technical stakeholder has tried to force a specific technology to solve a complex problem, it has been disastrous.

No, and in fact I am against TV advertisements of prescription medications. However, what I am challenging is the attitude Europeans (and some Americans) have that doctors should never be questioned, for they always know what's best and you should just shut up and follow their advice.

See, general practitioners have a very small amount of time to understand and diagnose your problem, draw the correct solution from their vast stores of knowledge, and prescribe something before moving to the next patient. In most cases they don't have time to stew about what your disease might be for hours and hours on end.

But guess who does have time to stew and research for hours, days, and months? The patient. And in the cases of chronic diseases, the patients can often become more expert in their disease (and related medicines and side-effects) than your average general practitioners.

So in summary, I believe:

- No, we should not allow TV adverts for prescription drugs

- Yes, patients should do online research about their diseases, including potential treatments and drugs

- Yes, patients should ask their doctor questions and make suggestions, presenting findings they've gathered

- Yes, patients shouldn't hesitate in getting a second opinion from a different doctor. Not all doctors have the same experience level.

- No, doctors should not bristle at this but encourage research, correcting misconceptions and answering their patients' questions. It's their body, after all

We are in agreement. Doctors advice should definitely not be unquestionable. In fact, there are a number of studies which show iatrogenesis as being one of the leading causes of death in the US.

Partially its about getting you to just talk to your doctor about your health issues.

A lot of people have arthritis, but don't go to the doctor. They'll pop some pain killers and deal with it like humans have forever. But a Humira commercial is designed to get them to ask their doctor about it.

Partially its get your doctor thinking about maybe updating your treatment. A lot of people just coast on whatever they've been taking for a long time. I've heard occasionally Doctors find patients who are medicines that are quite outdated.

Now all that might be worse than no advertising, but there are reasons behind it.

> Shouldn't my doctor morally and by default be suggesting the best treatment for what I have?

Of course. But how does the doctor know about my problem if I don't ask about it?

There are a lot of people with treatable conditions who have no idea that it's (1) a medical condition and/or (2) now treatable.

These ads will cause some of these people to go get treatment. That's undeniably good. How big that effect is, or if it's outweighed by bad effects, I can't say, of course.

You have to convince the doctor to prescribe it for you, but doctors take little convincing. The companies paying for the ads on TV are also taking the doctors out to expensive restaurants and giving them free samples of the advertised medicine. And of course doctors watch TV too.

All the incentives happily align.

Twenty-odd years ago, I saw a tv ad for the drug Paxil. It was about social anxiety disorder. Didn’t know that was a thing, so I never looked into fixing it.

Talked to my doctor about it. Got a prescription, took the medication for several years. It changed my life for the better.

That may be a culture difference, and it might not even be entirely healthy (with the god doctor syndrome), but from where I stand your relationship with your doctor and/or his skill was not where it should be if he doesn't regularly ask you the usually basic/boring questions that detect there is an issue to fix, and you don't naturally tell them you feel bad about X or you have this or that issue.

You’re assuming I went to the doctor regularly, not just when I had an issue to present.

Pretty much every studies show that the best working medical system are those with the best screening and prevention in place, among with are regular (usually free in Europe) checkup, accented for at risk population (child, aged people,...). Depending on your age in France there are lots of yearly /every 3 years checks entirely free that the national health agency push you to do.

So I may have assumed that yes but then if not it goes back to my original parent point of it being a sign of a broken system.

It is less than ideal in USA in many ways.

That my insurance, and by extension, my ability to maintain a relationship with any one doctor is tied to my job, means that when I change jobs, there is a high likelihood that I now may no longer have a plan available to me in a network with said doctor, or, if I do, it may not be available at the same price. And of course, a gap in employment or employment by a company that does not offer much or any coverage means an even more precarious situation.

Even if you're making the effort to get regular screenings here, there's a good chance youll be seeing a doctor who is both caught in a slog of appointments with a maximum length of fifteen minutes as dictated by the insurance company and who you have never seen before

The value of an ongoing relationship is something that is dismissed as valueless by large corporations who would prefer that all goods and services be seen as completely fungible - with the existence of any particular person on either the buy or sell side simply an irksome artifact of the system that they have not yet been able to squeeze out via automation or otherwise.

I get a $100 bill minimum any time I step foot in the doctors office. It's not somewhere I'm going to go for casual health questions. There's a fairly high bar that needs to be crossed before I even entertain the idea.

Direct to consumer TV ads for pharmaceuticals were illegal in 1981. This did not change until 1997. As I remember it, in the few years after 1997 there were still relatively few drug ads on TV. It was nothing like today. It seems like the number of ads has dramatically increased in more recent times I would guess because many large pharmaceutical companies lack the pipelines they had in the 1990's and are under more pressure to increase sales on existing drugs.

> It seems like the number of ads has dramatically increased in more recent times

Don't neglect to account that it may be that as you grow older, you are more likely to encounter these types of ads because the drug companies target older consumers as they are more likely to need the product.

I only meant TV ads. As for trying to guess about me, I watch almost no TV in recent times, though I did watch it back in the 80's and 90's. I am basing this opinion on only small periodic encounters with recent TV, random samples. I do not see internet advertising because I use a text-only browser except when doing commercial transactions. In any event, I use local DNS, no third-party "upstream" DNS provider. I never see ads. Away from home, I generally do not access the internet from mobile phones. It is a reasonable guess, though. No doubt Americans are being targeted by advertising like never before.

I was actually thinking specifically about TV ads. For example, drug companies advertise heavily during the evening news. Cereal companies advertise heavily during cartoons. It's always been this way.

It used to be forbidden to advertise prescription medication in the US but they changed the rule sometime in the 80s.

The usual format is lots of images of happy people walking in parks and spending time with family while a narrator says the drug name a dozen times and what it treats, then reads off a long list of side effects and warnings “blah-blah should not be taken by pregnant women, women planning to become pregnant”, “blah-blah should not be taken by smokers or those with reduced immune function”, “blah-blah may cause liver and kidney failure”, “deaths have occurred while taking blah-blah”.

Personally that makes me want to go suck on a soup bone and hope for the best, but for the larger population the ads are apparently very effective and scores of people who see them will go pressure their doctors to prescribe them or shop around for a doctor that will prescribe them. (Drug store clinics will pretty much prescribe anything if you can articulate having symptoms it treats - conflict of interest is obvious)

I'll take a stab at the simpler questions here:

> do you actually, you as the patient, choose which medication you receive for disease like that?

No, but I imagine patients liable to the advertising might mention a specific medication in a conversation with their doctor. Whether that has any effect depends on the advertisement/patient/doctor.

> Does your opinion override that of the doctor?

For prescription drugs, no.

As an American, what shocked me in the UK was the amount of ads for sports gambling. Literally every commercial during games was for a betting site. It felt pretty gross.

As an American we may not want to be throwing the proverbial stone in that glass house

To be fair, I think their point in this case is many countries are in proverbial glass houses, some stronger than others.

Exactly.

You're right, it's shocking, although I think it's mainly during sports (which sports nerds already pay a fortune for to subscribe to sky sports / bt sport).

The vast majority of TV viewing in the UK is on BBC, amazon prime, netflix or disney plus, and thus doesn't contain commercials, just adverts for other shows from the same provider. The rest of the stuff is mainly aimed at old people sat at home - visited my nan today, who had some terrible channel on (channel 65 or something). Adverts were almost entirely for stairlifts and to leave money to charities in wills.

That doesn't sound so dissimilar to the US :)

Ads during the day are either for old people or stay at home moms.

UK sports (or sports TV at least) is very tightly linked to gambling. Many football teams are sponsored by gambling companies.

About 15 years ago there was a huge debate about whether we should allow “American-style” supercasinos but we just did it through sport instead.

The only reason sports gambling isn't as big (or bigger) in the US is due to a historical aversion to gambling (thinly veiled piety in government), and because Major league sports orgs are still figuring out how to get the most money out of it.

Sports gambling is now quite large in states that have allowed it since the SCOTUS case a year or so ago. Still not a lot of TV ads though, more web advertising.

> I have a hard time reconciling what (little) I know about in the US medical system between insurance behavior, doctor choice, and ads aimed at patient choice.

As a patient, you don't get to choose what drugs a doctor prescribes to you. But you do get to choose (to an extent) your doctor. So if you ask a doctor about a particular prescription, and it's within the sphere of treatment options they would evaluate for you, then they'll usually give you that option. If for no other reason than to pacify you and prevent you from doctor shopping until one does give it to you.

To that end, medical marketing tends to work twofold: a salesforce focused on "educating" doctors on a particular medication, and patient advertising to get patients requesting it more. Doctors tend to have a go-to grab bag of treatment options they're familiar with and tend to prescribe, so both of these work to accelerate how quickly a particular new blockbuster gets its way onto that shortlist for any particular doctor.

Insurance companies, traditionally, operate as a backstop to prevent this from going overboard. Since they act as payor for both the physician and prescription, if they deny claims it can impede uptake. So they can put in place things like documentation requirements, prior authorization[1], and prescription formularies. That said, components of the Affordable Care Act (i.e. Obamacare) capped the profitability of insurance companies as a percentage of total revenue. Which doesn't really reconcile with trying to reign in costs, as runaway medical spending just means runaway premiums they can justify charging, and the absolute value of their percentage-based cap goes up.

[1] https://www.medicinenet.com/script/main/art.asp?articlekey=4...

The first goal of drug advertising is to define a category and convince people they have a disorder that no one had ever heard of before. Viagra invented "erectile disfunction" and went on to make billions of dollars, and an industry was born.

So in this context you are saying that HIV is a disorder that was invented by advertisers in order to sell anti-virals? Do you have any evidence to substantiate that(or your claim that ED is not a clinical condition?)

I read that in a way "invented" is usually used (esp due to use of "define a category"): someone was the first to do it. Not as in "it's an imaginary thing".

Are you suggesting that impotence is an invented ("medicalized") condition? I should start a physicians of hacker news blog... Prozac and premenstrual dysphoric disorder is a better example.

One reason that healthcare in the U.S. is so expensive compared with every other country is these adverts.

US TV costs something like $78b a year (based on 36% of $220b [0]), or $600 per household, on top of cable costs.

If 25% of adverts are for prescription drugs, then $150 a year of health spending is what you pay for the 6 minutes an hour of tedious healthcare adverts. (There's another $450 extra you pay when buying mattresses or whatever else is advertised on TV)

[0] https://www.emarketer.com/Article/Total-US-Ad-Spending-See-L...

I think the end game for pharmaceutical companies is something like this. They show this ad to 1 million people. Of those 1 million people, 3000 are HIV positive. Of the 3000, 1% ask their doctor about the new drug. Now 30 physicians research the drug and find that it might be more effective in patients that present with x or have y comorbidities. They start prescribing it in those cases. Rarely do physicians care about what it is going to cost the patient.

> ads for HIV treatment

To entirely ignore the broader point of your post: The HIV drug ads I see are about prevention, not treatment. Along the lines of "If you're at increased risk for HIV (you're a man who has sex with men), then you should take our new variety of PrEP, and reduce your risk of infection."

Thanks, that does give it some sense. It would still feel wrong if I saw that here, but at least I can get where its coming from.

For reference the only medicine ads you would see on tv here would be for every day things (paracetamol, eye drops, ...) or for BS like homeopathy.