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Or, I go to a doctor, who is a medically trained professional, and they prescribe a medicine to me based on their experience and training, without any incentive for financial reward?

Do you think that doctors don't have financial incentives to treat patients?

Not where I live. This is a uniquely US problem among first-world countries.

Technically I don't think it's unique to the US. In Denmark doctors get a fee per consultation. It's pay with tax money, but still the doctor is financially motivated to see patients. It might only apply to general practitioner though, I think hospital doctors are on a fixed salary.

One issue, that could excuse medical companies going directly to the patients would be a lack of knowledge among doctors. Doctors contently write prescriptions for medication that's no longer available and is often not as updated as a pharmacy on new medication. This means that at least some doctors aren't suggesting the best treatment, simply because they aren't aware of it.

The doctor can also put a generic name of the drug on the prescription and patient can tell the pharmacy to sell them a particular brand instead of a generic. So there is space where such direct advertising could work.

Ireland is extremely for profit in everything they do and very poor compared to many places in Europe in terms of response and quality.

People just assume a lot about the world.

I don't think it's fair to put Ireland in the same category as the USA here:

1. Zero ads for prescription medication anywhere 2. Medical card for everyone on low income covering everything 3. Never pay more than EUR114/month for prescriptions, no matter how much you medication you need or your income.

I've never had doctors pushing any kind of medication on me or my family.

Poor people in the US also get free everything...

I was curious about another HN poster from Ireland so I looked at your other comments and you're defending RTÉ so it's safe to say we won't see eye to eye.

You're a glass half full type of person, to put it in polite terms.

I could rant all day about media and health in Ireland. Specially from a migrant perspective but it's not really the place.

What is undeniable is that Ireland ranks amongst the worst in Europe and it's very much for profit. It's just Irish people don't know any better and they look at the wrong place (USA) and only at the money aspect, not the quality.

Quality wise, I'd much rather be in USA than Ireland because treatment here is terrible in many cases and there's always a sea of excuses and bureocracy.

A financial incentive to treat? No, that's pretty common across healthcare systems. It's being worked on as system move away from fee-for-service, but generally, the more a physician does, the more they make.

They should have an incentive to treat them, they shouldn't have an incentive to suggest specific medication.

For what it's worth, it seems doctors are heavily advertised to: https://slatestarcodex.com/2019/05/22/the-apa-meeting-a-phot...

My doctor is certainly not backed by investors who are putting her under pressure if she doesn't make 10% ROI.

No, I don't pay the doctor, the healthcare pool does. And then, the doctor is incentivised to cure me, not keep me in a perpetual drug-purchasing lifestyle as big pharma would.

Doctors get cash and hospitality benefits from big pharma though based on how they prescribe. If there is drug X from company Y and drug A from company B and then there is no difference in therapeutic benefits between two drugs, but company B gives doctor cash and has access to regional sales data where the doctor operates, they can modify the benefit based on sales. Then the doctor is incentivised to prescibe the A. This may be harmless, but if the doctor gets into a financial trouble or simply get overwhelmed by greed, this can quickly turn into something that harm patients. In my country doctors don't have to disclose those relationships and they don't even have to declare this as income.

In my country, general practitioners can only prescribe a limited number of drugs and specialist visits a month, so as not to overwhelm the healthcare system. It's their moral choice to deem a person sick enough for a certain course of action.

Whatever pill the doctor writes me up, I always end up asking the apothecary or looking up online the cheapest substitute. This is how the elderly here cope, they can barely pay bills, let alone choose which pills to skip. I've personally not had any problems with big pharma substitutes so far.

This is absolutely not true in most countries. Where I practice you can get into big trouble for this. You have do declare pharma affiliations, cannot accept sponsorship and the age of junkets through drug companies is long in the past.

I could be deregistered if I was found to be accepting anything (travel, hotels, conferences) and not declaring it

Wondering which country you are? can add it to the bucket list of countries to retire in.

Australia. This is the rule in most developed world economies, although I have to admit complete ignorance of the US (... the largest developed world economy)

I was invited once, by another doctor, to speak (paid gig, curtin closer) at a conference being put on by a pharmaceutical company. It was on digital health and the company I think may have had an interest in anaesthetic drugs or supplies or possibly it was surgical - (I’ve just trawled my records and without spending an hour or more I don’t think I’m going to find it) either way there were lots of Anesthetists and surgeons there, mostly because for only $100 they could knock off 20 CPD points by coming and listening to something half interesting in a nice venue for a while and get a meal and catch up with each other.

I had to fill out pages of forms with the company to get paid, firmly renounce that I would be promoting any drug or product, resolve to declare my affiliation with them for a minimum of 12 months, etc etc (this was in around 2018).

The company’s logo was on the pull out banners and the projection screens obviously but there wasn’t even a hint of drug or product anywhere in the room. No tote bag, just some mints and the pad and pen.

The ethical bar has been raised so high that medical companies are now reduced to running paid conferences on adjacencies that clinicians may possibly be interested in, that align with their college’s professional development goals, and can’t even mention their products!

So why do they even do it anymore? I pondered this as I filled out my forms - I believe it is due to residual infrastructure and marketing apparatus and budgets from the days when they could offer the world. Now they’re like vestigial organs, floundering to maintain purpose but knowing that a KPI is eyeballs on logos

The kicker is, if it was anaesthetics, there are only probably 2 makers of sevofluorane in the world anyway!

Great that your country stamped this out, but I am afraid you are the minority. Pharmaceutical industry is the most corrupt after politics and army and almost no doctor is immune to bad influence. Straight up denial is actually harmful in getting the truth out there and fixing the problem.

You aren’t saying anything substantial here. The world renowned scientists coming up with the discoveries that allow us to live long lives should not be bucketed with the MBA goons trying to mark up insulin shots and corner the market with medical patents they acquired.

What industry do you work in where those at the top of the companies aren’t maximizing their ROI and profit seeking? That COVID shot in your arm ID from the scientists that worked feverishly to invent it, and should be celebrated like the ones that solves medical mysteries across all different disease classes. R&D is not free period.

Why not have the government subsidize medical costs, why punish the inventor who have huge R&D overhead? The corruption you talk about starts and ends with the government.

You need to go to a doctor anyway. Not all of them are good, and imo they shouldn't have absolute say in what you take. If you suggest some medication you saw an advertisement for, they should take it into consideration instead of telling you to stfu about it. Yes, my experience with doctors has been terrible.

without any incentive for financial reward?

Except when they do get financial rewards?

https://www.nytimes.com/2019/05/02/health/insys-trial-verdic...

You appear to be assuming the advertisement medically benefits a patient.

I don't believe there's any evidence for this and ads for prescription drugs are banned almost globally for good reason. "Ask your doctor about" may bias the doctor away from a different drug that is more appropriate but has a lower profit margin, for example.

There's some benefit to the patient if the drug is effective treatment for a condition they knew they had but didn't know there was treatment for. Or if it's a new thing that treats something where the old treatment didn't work well or had bothersome side effects for the patient.

Major new drugs may get news coverage or may be brought up if a doctor sees something on your chart at a checkup, but ads may (or may not) reach more people.

Have you heard the expression, "A solution in search of a problem"? Because that what this is. Multinational billion-dollar corporations using their marketing dollars to convince people that their pill is the solution to all of your problems.

This should be illegal.

It either is or it isn’t, at the end of the day a Doctor was taught what to prescribe at med school and you can’t demand they prescribe you anything unless you are a drug seeker and will be blacklisted quickly if it’s controlled substances.

Go look at peer reviewed studies and clinical trials data to make an informed decision on medical treatment options.

I don't know why you were downvoted into the grey zone. I don't entirely agree with your points about Big Pharma finding needy patients instead of doctors prescribing based on professional experience (though there's still plenty of room for bias there too) but overall, fully agreed, the pharmaceutical industry is a wonderful thing on the whole, and while it gets a lot of knee-jerk hatred from too many people, i'd love to see somebody suggest something practically better (as opposed to ideally better based on their limitless dreams of a perfect world).

Maybe the bribery to get your Doctor to recommend a different drug than is probably best for you or your pocket book?

Maybe the campaigns pushing opioids on doctors and patients to the point of crisis?

Insulin is at least twice the price (depending on type might be 3 or 4 times) in the $US as anywhere else in the world.

There's that famous case where a Turing Pharma skyrocketed price of Daraprim that only they were manufacturing because, well, they could get away with it.

  "Insulin is at least twice the price"

That is the government's fault. What's the reason you can't import extremely cheap insulin from overseas? The government has endowed a local monopoly.

I don't think you can entirely blame unethical, predatory behaviour on the government that enables it.

It's not a government that enables it, it's a government that enforces it through laws that guarantee and endow a local monopoly. Whenever you have an endowed monopoly without substitutes, you have extremely high prices. It's econ 101 and will happen 100% of the time (that's why I call it enforcement instead of enablement). If the government just got out of the way, the price of insulin would plummet.

What's stopping US companies from competing based on price? There's multiple producers of insulin in the US. Why do you need a foreign company to undercut them? If an international market would fix it, why doesn't the national market fix it? Why doesn't one of the US companies charge less than the others?

Because of price fixing among the 3 big insulin providers, which is only possible in an environment where competition is heavily constrained by monopoly powers (or in this case, oligopoly powers) endowed by governments through the patent system.

If we have an international free market that encourages 10+ competitors that aren't banned from producing insulin due to patents, then price fixing becomes impossible.

So if government just got out of the way (in this case - patents and banning imports), you could import cheap insulin from anywhere and the problem would be completely solved.

So you think it's an accident that pharma corps make lots more money under the regime enforced by government? Or, possibly the pharma corps have engineered this situation politically (ie 'buying' politicians in some way - campaign donations, advisory jobs, etc).

Why else would gov arrange things this way of not at the direct [but covert] behest of the pharma corps? Do you think they're doing it (having overinflated prices for age-old life-saving medicines) to help citizens?

It's as you say - crony capitalism and corporatism. The politicians/government are corrupted and bought by pharma corps to create a situation where competition and the free market is stifled, which leads to high prices as the inevitable consequence. It's a principal-agent problem in the context of having a large state/government with extensive powers to interfere in private business.

You see this playing out everywhere; e.g. agriculture subsidies in rich countries, which just serves as protectionism for domestic farmers at the expense of poor-country farmers. The fundamental causal factor here is the large and powerful state - private, autonomous actors will always try to corrupt and co-opt the state's powers for their own benefit (whether that's farmers, pharma corps, oil companies, hedge funds, tech firms, or whoever), so laying the causal blame at their feet is misguided since their attempts to do so are inevitable. It's a government problem.

Why on earth should the patient choose whichever drug put money into advertising, rather than the one their doctor deems the most suitable? How could that possibly be beneficial?

edit: reading further down the article, there is an advert for an antipsychotic medication which offers a $15 discount on your copay. This particular medication has serious discontinuation effects, it's not something you can just stop taking and it's not something that is prescribed lightly in the first place. Offering a discount for the first few doses is plainly exploitative.

There are some aspects to the supply and demand of drugs, particularly psych drugs, that I'm not sure are described in econ 101 or popularly known.

Let's say the most common, first prescribed drug for your condition is available in a generic, for $0.30/month. That's not entirely hypothetical, that really happens.

A naive person would say "ok, if the generic is so cheap, then the brand name can't be much more, can it?" - free market competition, the FDA ensures they're all equivalent, blah blah blah.

However, I noticed that in recent years, the alternatives to the dirt cheap first-line option are way more expensive and going up. So I thought about why.

It occurred to me, that a simplistic view of competition ignores the fact that the different options are not exactly in competition at all. Because everyone tries the cheap one first, and then if they have problems or it's ineffective, they try another.

This means that fundamentally the drugs which are supposed to be in competition are not in competition practically speaking. If you have a drug that is not the first option, then you might as well charge $1000/month because everyone who is a possible customer already by definition has given up on the cheap one.

And even worse, in order to justify (for example) $1000/month, you don't have to have something better, just different enough to give people a little hope. They proliferate, but it's not progress.

Let's go ahead and see what the FDA found out about direct to consumer (DTC) advertising of drugs as they've conducted numerous surveys[1].

Not all bad it seems!

- 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.

- Physicians thought the ads did not convey information about risks and benefits equally well.

- Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

- 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.

- Doctors believe that patients understand that they need to consult a health care professional about appropriate treatment.

[1]https://www.fda.gov/drugs/information-consumers-and-patients...

If the blue tool you're talking about is an inhaler, I'm happy for yours being $6, as was mine I believe, but some still aren't so fortunate. They still go for $300-$500 for some people, in the U.S.

https://www.health.harvard.edu/blog/millions-skip-medication...

"Died because couldn't afford inhaler" will bring up some fairly good hits.

Things have been fairly good, and are always mostly getting better - but damned if we couldn't be so, so much better than we are given the other things our country fronts billions upon billions of dollars for is the idea always lingering in my and others minds.

Has everyone forgotten the OxyContin scandal? Or are we just all grateful that Big Pharma has saved us from the pandemic that we're going to overlook the past specific, illegal, actions of pharmaceutical marketing?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

> When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000.1 The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.

So one company running wild without government intervention selling a controlled highly addictive narcotic negates all medical discoveries by big pharma since the dawn of time including the record breaking speed of making a COVID vaccine? Yeah okay…

In almost all these cases the doctor should know what the patient needs, pushing patients to ask their doctors about certain medicines.

The one case I think drug ads are legitimate is when it's a dramatic improvement in treatment for a live-with-it type condition. The prime example would be Viagra--before Viagra there were not any good options, a patient very well might not mention it to their doctor so the doctor wouldn't know to suggest it. Thus "talk to your doctor about new options for erectile dysfunction" ads should have been acceptable to run for a while. I'm not sure what the medical situation was when the overactive bladder ads were coming out, that one might also be acceptable. I can't think of anything else right now.

Yeah so I guess the users have nothing to say in this. If I walk in to store they supposed to know what I want and a clerk puts the items into my basket and kicks me towards the checkout.

Are you serious?

The vaccine has me thinking of these things, and my reaction was closer to yours. I don’t think ads here are fantastic. What I think is fantastic is companies wanting to remove the “dis” from “disease”. But we must not rely on pharmaceuticals. They are just a few tools in the tool belt of healing.