In France, they fixed this by not allowing doctors or drugs to advertise. One of the best decisions ever, for a lot of reasons: you cut care cost, and you avoid that kind of third party profiteering.
https://www.fda.gov/drugs/prescription-drug-advertising/back...
I've been growing more concerned lately that today's youth might not be aware that things really were better just a few decades ago. I'm seeing a lot of mental gymnastics to rationalize behavior by big business that I consider indefensible.
Or to rephrase, I think that youth today do know that they are getting screwed, but for whatever reason, they often place blame on the wrong culprits. If we want to get back to the glory days, I feel that we need to revisit fundamental American values like truth, justice, civics, etc etc etc.
Or we can like, have even more billionaires and regulatory capture by multinational corporations taking us on an arrow's trajectory towards fascism. I can't even believe I have to write this, but that's how much the US has changed since I was young.
Part of why we aren't seeing that reoccur is that while expensive there is FDA regulation and the drugs more or less work even if there may be rightful concerns about side effects. They made sure they actually work so they rake in way more money than any small time quack.
Part of the issue with any return to glory days movement is that tradition is fundamentally a cargo-culted lie via induction. Traditions never were first done because they were tradition. The hard truth is the rot has always been there.
Ads for the former remain rare in my experience. Supply is tight (imagine an ad to join a 10 month waiting list) and insurance coverage is the critical entry point in searches for a new provider ( that a mental health provider is buying ads is testament to the continued lack of mental health parity / vibrant cash market there ).
Pharma ads are older than the FDA itself which practically grew out of the snake oil market. What many people experience as the explosion in pharma ads is really a broadcast explosion. FDA guidance around balanced reporting of side effects changed in the late 90s such that the brief “this may kill you” was newly possible. Lots written about this, eg:
Looking younger, the 20-something crowd doesn't seem to have much of a clue about socioeconomic issues and only sees politics through the lens of racial/gender/sexual orientation/gender identity politics. Their indifference to economic issues may be driven by the fact that they aren't yet old enough to have real adult financial responsibilities. The side-effect, however, is that the idea that socioeconomic conditions for the median person were better in the past is outside their scope of understanding.
Sadly, I don't see a solution for either incorrect blame targeting by 30 year olds or indifferent ignorance by 20 year olds. How these people are educated and what they are exposed to by mass culture is determined by the billionaires, and the billionaires are very happy with a status quo that deflects blame for social decay to anyone and everyone but themselves.
Patients are to be given therapies, to be helped and in the best cases cured. Not to be sold drugs seen in advertisements.
Medicine is not a free-market economy sector in Europe. Doctors should educate themselves about new therapies and use them when appropriate.
In countries other than America, healthcare is not for profit. It's not to maximize gains, it's to maximize care and allocate available resources for the public good.
Doctors are the ones who prescribe. Imagine: doctors don't even know what a drug costs, and nether do patients. The customers are government health systems, who study the value of a drug, negotiate prices and make it available iff the negotiated price is less than the value it provides. Its true facts that in Europe, healthcare is not a free market. This is how Canada works too.
Patients receive care as needed and don't need to be advertised to because they're not the customers.
ADHD meds are a great example. In America long lasting ADHD meds with fewer side effects were available for literal decades before they were available in certain EU countries.
Modern drug delivery systems that can slowly dose a medicine over 12 hours (!!!) are the direct result of pharmaceutical companies working to improve QoL for the patient.
The doctor, and especially the healthcare system, don't consider the patient's UX to be of that much importance.
This is analogous to having the CTO make a software purchase VS giving user's input.
Should the IT directors and CTO have a majority of the say? Of course. But the end users must be considered or you end up with painful to use software.
Patients aren't the customer in Europe because they're not buying the drugs. They're consumers, end-users even, but they're not buying them so they're not the customers. Frankly the same is true at any US HMO. The reduction in side-effects is considered by the health system when making purchasing decisions (as side-effects cost the health system money and reduce its ability to provide care on a fixed budget).
And yeah, at a company, the CIO is the decision maker, and the company is the customer. The employees are the end-users. That's why at a big company, employees may not always get to use the tools they want; they're not customers, and they're not making the purchasing decisions.
In both cases, the end-users and their needs are considered, but ultimately, it's not their names on the invoice and they're not the customers.
And sub-optimal results thus occur.
What happens with crappy drugs that technically work is that patient adherence is bad and the government + doctors say "well those poor people with mental disorders are just incapable of following the rigorous treatment protocol that we know works." (and you literally end up with people dying on the street)
Maybe now and then some innovation happens to try and improve adherence, but progress is slow. You can see this in the glacial pace that drugs in certain areas of the the mental health space have progressed. For mental health disorders where the patient is making a decision on the drug, each decade sees tons of innovation. Meanwhile for drugs that are "assigned" to a patient, progress is much slower and an untold number of people have suffered as a result.
I'm not saying free market healthcare is a panacea or that people should be able to pick any drug they want, but medicine should be designed to make people's lives easier.
And letting drug companies advertise "this drug is like the current drug you are taking but has 1/2 the side effects and won't cause your hair to fall out so ask your doctor today!" isn't the worst thing in the world. It means patients will demand their health insurance covers the drug, and it means patients will force their doctor to read up on the drug.
Without the patient being a forcing function there is literally zero motive (beyond altruism) for those two things to happen.
Depends, employees at higher end employers have more say. Since health benefits are "feature" employers have motivation to make their benefits package better to attract employees.
Heck one of Microsoft's defining features as a company used to be their health insurance package. Everything imaginable was covered 100%, no out of pocket costs ever.
I'm still completely confused as to how acupuncture is covered by so many insurers though...
Fertility treatments would likely be another "by popular demand" addition.
Doctors become the customers and sales reps will go directly to them.
But what is covered or not covered are decisions made by governments. Those decisions sometimes forces bad medical practices. On the extreme end a doctor in Toronto was giving a drug to force the baby out of mothers before the due date always on the weekend so he could get overtime. Minor examples are being sent for slightly related tests meds because they are covered vs a more expensive test that would work better but is restricted (the ultra sound vs mri)
It’s like my non-technical boss coming into the office and telling me that we should start using technology X that he saw in an advertisement. Typically, with my boss, he sees something at a trade show or a trade magazine or in an email, and becomes convinced that it is the best thing ever for us and will solve all of our problems. Then we have to put forth a lot of effort convincing him that he is wrong (he has never brought us anything remotely useful) without making him feel dumb.
How about he lets us technical people recommend to him the appropriate technologies instead of the other way around?
After I saw what is happening regarding the coronavirus, this scares me.
That's why pharmaceuticals have sales reps visiting MDs, sponsoring seminars, etc.
People act like "doctor knows best; don't question their wisdom; they have their secret sources of information and you need not concern yourself with that"... yet I as a patient would like to know about all the options on the table available to me so I can do my own research. How do I know an old doctor isn't being biased toward old tried-and-true treatments, and new doctors aren't being biased toward shiny new bleeding-edge treatments?
The same fallacies and biases that affect software developers affect doctors too. Doctors have limited time to think about and research ("debug") my condition, I have a lot of time to research ("debug") my condition.
I'm not saying "advertising" is the correct solution to the information dissemination problem, but surely there could be an alternative solution like some kind of "medicine wiki" that would allow patients to discover medicines related to their conditions.
I think Viagra is a good example of this -- it used to be common for people to assume ED was just a part of "getting old" and not a treatable condition that they even could talk to their doctor about.
In a report from 2015, the FDA found that there were benefits (shocking!) and drawbacks to DTC advertizing.
Positives:
- Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.
- Many physicians thought that DTC ads made their patients more involved in their health care.
- 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. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.
- Eighty-two percent responded either "very well" or "somewhat" when asked whether they believe that their patients understand that only a doctor can decide whether a drug is right for them.
Negatives:
- 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs
- Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.
[1]https://www.fda.gov/drugs/drug-information-consumers/impact-...
But do you want your doctor prescribing something they’ve glanced at for 5 min?
Take a look at the label for a random drug, it’s often 20 pages or more of data. Doctors, rightfully so, don’t want to prescribe something unless they are well versed in benefits and risks. That takes time and effort.
I’d much rather have them base it on a 30 second tv commercial I’ve watched.
That's a huge negative in my mind. Blind faith in doctors is terrible for health.
DTCs have a point and being involved in your care makes sense. Doctors also get plenty of doctor-targeted specific advertisements/incentives as well (some less ethical than others)
The main issue I see is that ads might be pushing for the "latest" treatment which might not be the most effective or have the best cost-benefit.
On top of this, the majority of drug consumers are old people, who (statistically speaking) are far less likely to even use the internet at all. This is why drug advertising can be quite useful for them.
[edit] Nobody's making the case this information should be secret, just that it shouldn't be delivered directly to your face during episodes of Futurama. If you want to know what your options are by all means, pick up the pharmacopoeia.
I made this argument recently -- in Canada, DTC advertising of prescription drugs is illegal, too. Has been for years. There's a reason physicians go through years and years of medical training, and its not least to be able to identify and manage side-effects, drug interactions and perform appropriate diagnostics. You spending 30 seconds watching an ad are not ready to self-prescribe Skyrizi or Oxycontin.
Doing it wrong could lead to death, dependency, or in the case of self-prescribing antibiotics, community issues in the form of antibiotic resistance.
This is something you need to have a minimum basis of knowledge to interpret and understand, and pharma companies are taking advantage of a knowledge gap to push drugs circumventing the professionals. It's people who know more than you taking advantage of the fact you don't to make a buck.
The same argument could be made of drivers licenses, right? Well I know how to drive, so what business does a cop have telling me I need a license or to go to traffic school? The answer is simple: you can harm yourself or others if you don't know what you're doing, and the decision is made at the population level.
Plus we're dreadful at self-administering medicine. 75% of American adults take some form of multivitamin or supplement. Most supplements are useless or harmful [1] and multivitamins are associated with an increase in all-cause mortality [2,3].
Let's leave the medicine to the medical professionals, yeah?
[1] https://informationisbeautiful.net/visualizations/snake-oil-...
[2] https://jamanetwork.com/journals/jamainternalmedicine/articl...
Partially disagree. Yes, they are a very important source of information, but ultimately it is your body and information should flow freely both directions so you (the patient) are empowered to make the best possible decision.
Anecdote:
Doctors are not omniscient. One time when my sister was in high school, she went to the doctor because she had a weird rash. My mom researched skin rash images online for hours and concluded it was shingles. When she brought it up to the doctor he laughed and said my sister was far too young for shingles and that it was probably just an allergic reaction to something she ate. He prescribed some topical ointment to see if it helped.
Well, my mom didn't like that and took her to a different doctor who, unprompted, said: "wow, that looks like zoster (shingles)!"
My personal trainer took a look and was like "dude, one side of your right leg is jacked, the other side's not, that's your problem".
Heck a few months ago my dentist wanted to give me a root canal because hot food was causing pain in one of my front teeth. I started wearing my night guard again (...) and the problem went away in a week.
And let's not even get into how miserable doctors are at treating acne, when I was a teenager the official medical word was that diet didn't impact acne. Well, turns out, it's been shown through nice detailed studies that milk can inflame acne.
My first blog was detailing an elimination diet to find out what food stuffs made my acne worse, few years later studies started coming out confirming what people had been saying for literally decades, food can impact acne!
Heck to this day if I splurge on cream I'll get a white head or two.
What the doctor did do was prescribe me an antibiotic that I took for 5 years (!!!) that ended up causing low iron and didn't do much of anything for my acne.
Doctors have to cover a lot of ground, they don't always have time to learn about every treatment option for every possible human ailment.
You'd need some sort of non-profit repository that indexes all drugs as they become available maybe?
I actually like Canada's compromise, where drug advertisers are allowed to tell you that a drug exists to treat a condition (without telling you what that drug is), or reminding you that a certain drug of a certain name exists, without telling you what it does.
[1] https://en.wikipedia.org/wiki/United_States_Pharmacopeia
The above probably isn't humanly possible for everything.
That is unfortunately what most people do and it can lead to poor results for the patient:
>...Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error in the U.S.
https://www.hopkinsmedicine.org/news/media/releases/study_su...
They counted every death the involved medical care as a medical error death if any sort of imperfection at all was noticed in the case. One of their famous examples was a patient who had a stroke or something and then died "because" he wasn't adequately warned to not go for a jog during recovery, who then had another attack during a jog.
We can (and should) do better than that. Part of this is that patients have to take some responsibility for their care and get second opinions, read up on the diagnosis they've been given, etc.
A 30 second commericial isn't enough but a 5 minute doctor appointment isn't that complete either.
Direct to consumer pharmaceutical ads are the global exception.
https://en.wikipedia.org/wiki/Direct-to-consumer_advertising
1. patient sees ad for drug promising them a normal life full of beer and children, and ample slightly serious sport/exercise. 2. patient calls doctor and excitedly informs doctor about awesome new life changing drug. 3. doctor tells patient why drug is not appropriate. 4. patient gets revenge for crushed dreams by leaving horrible reviews for doctor everywhere they can. 5. oh right it's a business, society tells the doctor, not health care. 6. doctor accepts stupid reality, and prescribes medication.
Some have simple sites, most have marketing-sites, plenty with keyword domains.
No. In most countries doctors and drugs don't need any SEO, because the doctor is provided by the health service, and the doctor picks the drugs based on clinical indication.
Most people I know go private (out of pocket, it's about £20-80 per session in London so on average about £200/mo).
Discovery is done through word of mouth or looking at various schools of therapy and shopping about to find a therapist that works for you.
Most therapists here don’t accept insurance, many insurance plans don’t cover mental health, and government programs don’t cover it at all.
£20-80 per session sadly sounds like a deal here in the US.
I just searched what it’d cost me here in NYC to purchase and go through the insurance my therapist does take (in-network): The plan costs about $650/month and I’d have to hit a $5,500 deductible before mental health coverage kicks in. Then it’s a 50% coverage after that. I’d pay about $6700 out of pocket with insurance versus about $7350 without it. This doesn’t include the $7800 I’d have to pay for the plan itself.
I wouldn’t really call that a mental health benefit, it’s easier to just find a therapist you like and just figure out a way to pay for it if you can. Most people can’t and it’s a shame because good therapy is transformative. My life is so much better because of it.
Germany has a rule for public insurance where you need a referral to specialists from your general physician (but that's not the case for the ~10% that are privately insured), but you can freely choose that doctor, your dentist etc. Since the public option doesn't cover a lot of the latest therapies (... not even glasses unless your eyes are very bad!), there's a secondary market where patients pay privately, or have a special private insurance for certain things.