Comment by a_puppy | Hacker News Reader

Comment by a_puppy | Hacker News Reader

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Hmmm, the marketing question is complicated and I'm not sure what to think.

From a profit point of view, presumably the advertising department pays for itself; in other words, the advertising department generates money for the R&D department, rather than taking money from the R&D department.

But, the advertising presumably increases the number of people taking the drug. If it's teaching patients/doctors about a valuable new drug that will make peoples' lives better, then it's a social good. But if it's persuading patients/doctors to buy the drug unnecessarily, then it's a waste.

(Also, sometimes two pharma companies have competing drugs that are basically equivalent. So they get trapped in a "Red Queen's race" where they both spend money on advertising to try to gain market share. In the end they've both spent a bunch of money on ads and ended up back where they started. For those cases, banning marketing would be a clear win.)

Edit: Also, keep in mind that "ban/regulate pharma advertising" is a different proposal than "medicare negotiation".

You're thinking at the level of one drug. But that's not the right level, it misses too many second order effects.

If someone is sick, they've likely been diagnosed by a doctor, who will treat them. This is how the consumer will know at all they might want to take the drug.

So the effect of the advertisement is to change the course of treatment as the consumer will ask their doctor for that drug ("ask your doctor if $drug is right for you"), and a doctor needs to prescribe it to begin with.

So the "Red Queen's Race" is not a sometimes. It's in fact almost always the situation at hand, generally between multiple courses of treatment.

We can observe from countries with no prescription drug advertising and similar levels of development that health outcomes are broadly similar. So we can be quite confident that this kind of advertising doesn't lead to significantly more appropriate treatment in aggregate, and it's therefore most likely to be a race to the bottom.

I'm not an expert on this stuff, so I'm not sure what's the answer. But this article says that about 90% of pharma marketing dollars are spent on marketing to doctors, not to consumers: https://www.pewtrusts.org/en/research-and-analysis/fact-shee... So it seems like pharma companies are mostly spending money on R&D and on advertising to doctors, not on direct-to-consumer advertising.

This is not true anymore, as advertising to patients has been the major driver of growth, perhaps due to Medicare and the rise of expensive biologics, leading to advertising to consumers becoming the predominant sink.

In 2016, pharma companies spent more on direct to consumer ads than they spend on marketing to doctors (excluding free samples, which are somewhere in between, though ultimately the drug being free is really of concern to the patient far more than the doctor), see: https://jamanetwork.com/journals/jama/fullarticle/2720029

In 2016, we have 9.6 billion in direct-to-consumer spending, 13.5 billion in free samples, and 6.8 billion in everything else. So clearly, advertising to consumers is the dominant venue.

That hasn't been true for awhile, mostly since it's now illegal to send doctors on expensive junkets or offer more than the smallest dollar amount inducements. So Big Pharma has intensified D2C marketing, where they can exercise much more leverage and prey on the relative ignorance of the average person.

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