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Comment by DrBazza | Hacker News Reader

Sort-of-related, for Americans reading this, from a Brit, when I watch US TV programmes, the inclusion of drugs (prescription and illegal) in scripts is so matter-of-fact, it's actually shocking. Comparing like-for-like programs (police dramas, hospital dramas, thrillers), the UK version will invariably have entirely different plots. Sure the US != UK, but it's so weird.

Isn't the USA the only country other than NZ that allows advertising of drugs on TV? Also sales reps from drugs companies isn't a thing we have here either (largely because the NHS is The Buyer of all drugs in the UK).

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The TV advertising is really gross and annoying. And IMO, gotten much worse in recent years.

I hadn't watched TV in years before I went to Southeast Asia. I always laughed that it seemed all the commercials were for coffee and beauty products, rarely anything else.

Then I happened to catch live TV for the first time in a while after I returned, and realized it seemed 80% of the commercials were for random drugs. It made me wish we had more coffee and beauty product commercials!

I recently went sober from alcohol and afterwards realized how much alcohol advertising there is, it's actually pretty insane. For certain programs (like football) it's almost %50 of the ads.

Prescription drug sales reps market to doctors, attempting to convince them to prescribe certain drugs more frequently. Who pays for the drugs is largely irrelevant to that interaction, but I wouldn't be shocked to learn it's illegal in the UK.

> Prescription drug sales reps market to doctors, attempting to convince them to prescribe certain drugs more frequently.

I dated a girl who went into pharmaceutical sales. They're basically bribed. They get kickbacks in some form or fashion.

They get invited to speak a medical conferences by drug company reps, those conferences just happen to be at luxury retreats.

I worked in the industry and it’s not really like that (at least the ones following rules).

Certain hotels and resort chains are banned for those types of events (Ritz Carlton, etc). All payments are “fair market value” based on the doctor’s typical compensation rate (say $500/hour for oncologist). All payments are reported to the government under the Sunshine Act.

To be honest, it’s not that lucrative for the doctors at all. They could be making more money elsewhere.

Not really. The speakers are paid for their time and get a free meal. But those in the audience get a free meal, which you can't bring a non-medical person to, and which most doctors could easily afford on their own.

Medical students and residents will attend these, because they can't afford to eat those meals.

Now, the device industry... that does not operate under the PhRMA rules.

The one drug I've ever given a talk for (sugammadex, trade name Bridion) is an excellent drug that has a unique mechanism of action for which there is absolutely no equally-efficacious substitute. It is expensive, at around $90 a vial cost to the hospital, but it can and has prevented overnight ICU stays that would have cost the hospital far more. I was a big fan of the drug even before it was released in the US, so I didn't need a bribe to do the talk. But if they're going to pay someone, I saw no reason it shouldn't be me. I didn't say anything I didn't already believe.

Back in the early 2000's I drove for a proto-doordash (no apps, cell phones, or GPS, just two way radios and a local map book) food delivery service. The best jobs were always the pharma reps buying $500 of lunch for a 5 person doctors office. Could walk away with $100 in tips from a lunch shift.

It’s not. They have drug sales reps in the UK. I actually don’t know of any country that bans them.

I mean, if a doctor has a question about a drug, who better to ask than the rep from the company who makes it?

I worked in the industry and reps are generally account managers for the company.

>if a doctor has a question about a drug, who better to ask than the rep from the company who makes it?

ideally a third party in the form of a board of scientists who don't have a direct conflict of interest. Look at the billion dollar settlements of J&J in the last decade alone for misleading marketing and health risks from products including hip replacements, psychoactive drugs and implants.

Those already exist and are accessible.

But if your patient is having a specific side effect and you want to know what information is available, your only choice is the company because they collect the information.

To ban sales reps is like running a garage to repair cars and never talking to the manufacturer.

Does the UK have those bizarrely obtuse not-an-ad-for-prescription ads like in Canada?

I can't think of any although maybe some erectile dysfunction drugs are (don't know if they're prescription only or not). Otherwise, there's ads for cold remedies, cough medicine and analgesics. The idea of advertising prescription drugs seems bizarre to me as surely you'd want your doctor's opinion, not whatever's on daytime TV

US ads for prescription drugs typically say "ask your doctor about [drug]". I think there's a regulation saying that an ad describing what the drug treats must also discuss risks and side effects, but there are sometimes ads that don't say what the drug is for, merely suggesting anyone watching talk to their doctor about it.

Viagra is now over-the-counter in the UK. It's only legal to advertise General Sales List (stuff anyone can sell, like aspirin) and Pharmacy (can only be sold by a pharmacist, like co-codamol) medicines to the public. Prescription drugs can only be advertised to medical professionals.

I would have to check more of Ofcom guidelines, but it's likely in there somewhere that drugs (with exceptions you mentioned), like cigarettes are explicitly prohibited from adverts.

In fact:

https://www.ofcom.org.uk/tv-radio-and-on-demand/broadcast-co...

probably tells you why those 'little blue pill' adverts are only on after 9pm.

In my limited experience, you get better results from GP visits if you come with opinions and data about your own conditions and care hopes. They’re too busy; the current system that has forced 10min bookings weeks ahead as the only means of access means it goes better if you do the research for them.

I agree, but wouldn't consider watching TV to be meaningful research.

It's not, but it's hard to argue that TV advertising is (or was until very recently) a great way to get your drug's name out to the public. It's hard to research something you don't know about, especially before the Internet was commonly available.

Of course, the drugs with ads are usually the most expensive name brand drugs that will earn the pharma companies a lot of money.

In the UK, we don't see a drug on the TV (other than headache tablets and cough syrups) and then demand our doctors prescribe them. We visit a doctor who makes a diagnosis and prescribes the appropriate medicine, if necessary.

The FDA’s own research suggests otherwise. DTC isn’t perfect but has a lot of benefits according to doctors surveyed:

- Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.

- 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. Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. 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.

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

- DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. 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.

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

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

My experience if you do your research your labeled as a hypochondriac and given anxiety meds. At least until you are nearly dead, then they sort of listen

Oh you show signs of strokes and autoimmune condition? Here’s some chill pills.

Imagine the TV asking if you're feeling down, not quite right and many other euphemisms for depression while being very careful to not use medical terminology, then suggesting you to go see your doctor.

The US and particularly online cultures seem almost obsessed with drugs and I have a hard time believing it is only due to the taboo aspect of it.

I though it was brought partially by wealth gaps and hopelessness. The drugs epidemic in the US is now at least 50 years old (maybe a bit better between 2000 and 2008?). Two generations were raised while it existed and that more that anything banalized drugs. Fentalyn might be the latest one to trend, but it was Opioid, Meth, Cocaine, Crack and LSD before, all the way to the 70's.

I suppose Isolation during Covid might play a role, but I have not seen any stats relating drugs and the pandemic so far.

A culture hyping 70-hours weeks and over-employment as solutions to cost-of-living issues is not healthy, and drugs are just one of the symptom.

Fentalyn isn't really the problem. The need for drugs to escape/cope is.

I think there might also some incentive to pad media runtimes for streaming services to make it look like they have a lot of content. And a drug induced high sequence is cheap to film.

Lots of content that should be 90min or 2 hours at most is now 4 hours or more.

I simply stop watching or fast forward through that nonsense. If I wanted to see people get high and drunk over and over, there are more entertaining venues.

Single buyer, is not what the lobbyists wanted. It would make the lobbying sellers less powerful...

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