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Is Direct to Consumer Prescription Drug Advertising in Patient's Best Interest?

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In recent decades there has been a development of what has been called "consumerism"--that is, a greater concern of the public who spend their money for goods and services to be sure that their interests are being served and, in turn, a response by the providers to pay more attention to the publics demands. In the medical profession, this consumerism has lead to changes in ethical philosophy and, for example, causing physicians to be less paternalistic in their dealings with patients and have more concern for patient autonomy. Recently, in the pharmaceutical industry, with the relaxation of advertising standards, consumerism has lead to what has been called "direct to consumer advertising" of prescription drugs. This advertising involves magazine and TV ads suggesting the use of various prescription drugs for medical conditions the viewer might experience and also suggesting that the viewer ask their physician if the medication would be appropriate for them. The viewpoints about the use of these ads are divided. Some feel that the ads provide medical education for the public which may not be provided in another way and show the viewer other options which are now available for their illness. Some feel that the ads are misleading, self-serving to the drug companies, lead to viewer self-diagnosis and place an unnecessary burdern on physicians who must respond to their patient's questions about some medications, for example, which are new and about which the physicians may not have had any experience. What do you think?

Here is the question:

Is Direct to Consumer Prescription Drug Advertising in Patient's Best Interest?

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Direct to consumer advertising has had very positive effects on language, and for that reason has proven valuable.

Direct Marketing requires respectful address: Buyers do not respond positively to disrespectful address. One clear example is marketing to 1.people with 2.diabetes, a person first form of address: Person before label.

In mental health there have been specific benefits as people learn to name illnesses- the profession has not been particularly interested in doing so, has far too often employed the generic "mental illness" for all diagnoses, or has resorted to adjectival nouns, "diabetics", "schizophrenics", conflating the person and the illness. The public, and individuals so labeled, have reacted to this stereotype with disrespect.

Harold A. Maio, Consulting Editor Psychiatric Rehabilitation Journal Boston University

Hello DoktorMo, I think the government must include this type of advertising in a Do Not Call type of list, it should be on pay per view TV for only those who want it!.............I visit my Doctor for professional advise, not to pick the Doctors brain for this type of TV info sale stuff..........When a person is sick they try anything and this would be right up their alley...........Would this work? Will this be OK? Do you think this would be better for me............ A bunch of questions that wastes the Doctors time and efforts to help you.............Very interesting website.......SteveD

The advertisement of prescription drugs to the consumer and to the general public creates a need for a problem that isn't really there. By asking questions that are so vague (i.e., are you tired, not feeling like your old self, etc.) a consumer will ponder these thoughts until they have convinced themselves that there really is something wrong with them. This isn't fair to the consumer as well as to the medical doctors that are feeling the pressures of prescribing things that aren't needed.

Let me know what you think

I think not. Until we use litigation from delaying the introduction of generics to the market place, we will not see DTC advertising go down. This is how most Large Drug Manufacturers are getting away with not waiting the appropriate "patent period" expiration so that a generic can be produced. Instead, we have all these brand name drugs with fewer side effects, or different side effects. I am in support of the Senator John McCain proposal to use litigation from delaying the introduction of generics to the market place, which I think is roughly a 17 year patent.

DTC (Direct to Consumer) advertising on prescription drugs are escalating to a point that last year, the drug manufacturer for VIOXX spent more money on advertising than a company as large as Pepsi Cola. This is getting insane. I think physicians need to encourage their patients to eat right and exercise before writing the prescriptions for these cholesterol medications etc. However, it is getting more difficult because we are a Consumer Culture. It's easier for us to take a pill then it is to eat right and exercise. That's the whole premises behind the advertising.

However, the drug store chains are a whole different story. The mark up on generics has been significant because the yield isn't as good on brand name drugs. There was an article in the St. Petersburg, FL Times in May 2002 titled "What makes an 8 cent pill cost a $1.29". If you get the opportunity to go out on the website and read it, it's infuriating. Some of the retail drug chains are marking up some drugs from 300% to 3000%. Remember this when you see the new construction of some of these drug stores on huge corners on major intersections. Some, across the street from their competitors........... This is my opinion.

I like to be knowledgeable about health issues and treatment. I do not expect a doctor to be a teacher but I do expect him to be helpful and open minded. I do not like when a doctor is paternalistic or for him/her to have legal control over decisions concerning my health. Advertising by it's very nature is manipulative. I never make decisions about anything based on advertising. Advertising has nothing whatsoever to do with the quality or truth about a product. Hype is very expensive and of course it probably doubles the cost of anything. Why would anyone with a brain request a drug because it looks good on tv. My aging mother and all her friends chronically complain about the costs of drugs. It is one of the larger issues of this time period.

For the average person, the medical community is a virtual minefield fraught with medical care that has lost sight of it's true goal and is linked to pharmaceutical companies. It is a business machine and has lost sight of the patient care as a service profession. Why would everyone want their kids to grow up to be a doctor. Believe me, it has nothing to do with altruism. I try very hard to see it that way as it keeps me in the real world unlike my parents generation who thought doctors were like priests and government officials and whose word was not to be doubted. We know what kind of trouble that can get one into. It puts the patient in the role of a consumer. One must be an educated consumer. Thank god for all the advocates and watchdogs for public welfare. Thanks for all the good advice that is shared from one friend to another.

Barbara Velazquez, Teacher, Brooklyn, NY

If the FDA provides a way to ensure that consumers are not being mislead with the prescription medications, then it is a good way for patients to learn about new drugs that may help them overcome an illness. It may send them to the doctor with questions that help to start a conversation. The Kaiser Family Foundation did a research project to try to understand this better. Just putting my two cents in.... doing research project for my nursing classes and found this site. Junemarie

I feel advertising for prescription drugs should not be done. With the ever rising cost of healthcare, the money used to promote the drug should be used to make the medication less expensive and used to provide medication to those who otherwise would not be able to afford the medication.

Direct television advertising should not be permitted. a 30 second spot is not adequate to present the information necessary to guide a consumer. It has resulted in broad over medication. Drug companies spend more on advertising that they do on research. This all started very recently because of a back room decision of some fda bureaucrat.

There is an assumed profit motive for the drug companies to advertise directly to consumers. The common explaination of high drug costs is the expensive development cost of the drugs. I would suggest that the development costs are less than the advertising cost, resulting in significantly higher prices to consumers.

The process of patent protection, in effect, gives the drug company a monopoly for the duration of the patent. The patent system make a great deal of sense for "nonessential" products. However in the case of essential monopolies such as utilities, the government provides regulation to keep the costs and prices under control. I would suggest that to a consumer with an essential need for a patented drug, the cost of advertising should be eliminated.

Regulating patented drugs like public utilities would be on way to control this.

Burl Romick, Portland, OR

My answer is NO. Direct advertising of prescription drugs to consumers is not in the best interest of the patients because they may influence their doctors in deciding the type of drug(s) to treat the patient and the high cost of TV commercials and magazine advertisements paid by pharmaceutical companies are eventually built into the price of the drug, which is one of the major reasons of elevating the drug price. We should urge our legislators to enact a law to prohibit such direct-to-the-consumer advertising of prescription drugs.

Sincerely, John

Could there be useful direct advertising? Yes Is there useful direct advertising at this time? No The problem in that the parties funding this "information" have a vested interest in altering consumer behavior to utilize their product. They are using agents advertising agencies) with a long track record of lies and half truths who operate under the banner of "Caveat emptor" There is almost never full disclosure of risks (there is never enough time) or of alterrtnative therapies. The advertisements send patients to their doctors preprogrammed to demand the newest most expensive products and they are resistant to alternatives which might be "older" and so obviously less effective drugs. The physician must then choose to take additional time to try to educate the patient including basic pharmacology, simply refuse and risk loosing a patient or concede because "it is their money." The end result is the squandering of resources on unneeded and over priced medications.

Generally speaking the ads we see in the media are misleading, suggestive and give fuel to hypocondriacs around the country looking to annoy their physicians with second guessing self diagnosis. But speaking of suggestive, what the heck is "Zyrtec" trying to prove with their most recent ad? It's bad enough being repeatedly inundated with constant rambling about new prescriptions from every form of media. But when they bring in an ad featuring lesbians as co-afflicted individuals, that takes the cake. Just another step toward lowering the standards of decency and morality in order to tap into (sadly) an ever growing market. Bottom line - MONEY!!!.

The way prescription drug advertising is done now is not in the best interest of patients. These ads drive up the price of already-profitable drugs that may be no more effective than ibuprophen. In addition, the ads suggest that there are no alternatives, or that the alternatives are less effective (e.g., Aleve, which is not a prescription but works well and could easily burn a hole in your stomach in short order).

As always, viewers are encouraged not to think about diagnosis. A single set of symptoms could accompany flu, encephalitis, West Nile virus, e coli, and a dozen other serious things.

Again, we are to believe that no discomfort can pass without a pill or an anti-gluttony anodyne.

Prescription drug advertising is for the benefit of pharmaceutical companies.

There! I said it and I'm glad!

Annie

Expensive tv advertising only means that the drug companies make too much money.

This is so ridiculous. when you approach a doctor with your problem it is hard enough to understand his medical lingo, without advertisers throwing 'miracle' drugs at every tom, dick and harry who has a health problem. advertising a product not only informs the consumer of its function, but also positions the consumer in such a way as to perceive the product as a desirable commodity. well goddam, do we really need a whole other generation of users, convinced that they need a new drug?? advertising is not informative. it is a marketing tool. consumers are not perceived as 'resistive' readers. we are perceived as a bunch of bank accounts, all ready to be brainwashed by the first company to confuse us with some chemical terms and a brand new wonder drug. i doubt whether it will be possible to prevent drug companies from advertising their wares, but it is possible for us all to become resistive readers, consumers who recognise a sales pitch when they see one. leave drug prescriptions to the doctors (if they too have not been warped by the promise of MONEY), do not beleive all you are told, and learn to read between the lines.

Hi Dr. Mo,

I think that direct marketing to consumers, as it is currently being conducted, is a mistake. Most people do not have any idea what they are dealing with in terms of the chemical structures and interactions of drugs; hence the obvious increase in injury or death that we are seeing in the general population as a result of self-medication.

Most humans think in terms of symptoms, and occasionally in terms of a given disease or disorder, if they have a definitive diagnosis. They then match this information with the promises they hear in ads, and proceed march to their doctors claiming that this or that drug is exactly what they need, at which point, many doctors will capitulate without really knowing much more about the drug than the patient does. This is a dangerous state of affairs, but it's basis is found in the profound lack of time doctors have for their patients. What is the length of the average visit? Fifteen minutes? No way can anyone get anything health-related done correctly in fifteen minutes!

There is one way that direct marketing of drugs to consumers might prove helpful. This would be to introduce the drug, what is made of, what it is for, etc. so that people know of its existence, but that's all. No sales pitch. Doctors and pharmacists need to communicate with each other regarding effective treatment. Too often, the pharmacist is an "after-the-fact" component of the medical process. Pharmacists could tell people about drug interactions, thus discouraging excessive self-medication. I'm not sure whether or not this would work, but I think that changes in formularies are so swift that doctors (and patients) cannot afford to leave pharmacists out of the loop. I've even heard that some people are now calling their pharmacists more often than their doctors!

The other option is to have no ads about drugs at all, but then, if the doctors don't know about pharmaceutical advances, what's a person to do? The web is an option, and maybe everything will one day be a matter of accessing necessary information from some form of WebMD. However, this doesn't help patients without web access ... which brings us full circle ... back to better communication between medical professionals.

Sincerely, Suzanne du Vair Wisconsin Department of Health and Family Services, duvais@dhfs.state.wi.us

If the intent and result of direct to consumer marketing of drugs was a better informed consumer and lead to focused discussions with the consumers physician, I might find reason to support direct marketing. That is not the outcome that I have seen. Perhaps the recent marketing of Nexium a good example. A radio announcement touted the benefits of the "purple pill" but did not explain the targeted or appropriate use of the drug. I checked www.purplepill.com to discover that the intended use was for GERD (heartburn). Both the web site and a magazine insert offered to provide a "free" trial sample.

In light of the multiple reasons for heartburn, if the patient does in fact have heartburn, the patient needs to be worked up for the symptoms. Most heartburn symptoms can be alleviated by diet and over the counter products. For chronic symptoms, there are a range of products that may be effective. Nexium is new to the local market. I view the marketing of the drug, which may or may not be effective, as just that, marketing. There is no effort to discriminate the advertising of the prescription medicine to the group of patients most likely to benefit (if any). Education is not provided. The information provided in the ad is primarily the glory of the color purple, as opposed to the "little blue friend" that Bob Dole endorses. In light of this type of blanket advertising, I see no benefit to consumers or medical professionals in the direct marketing. I can see increased somatic symptoms of some patients who use the information on the web pages to craft their symptoms. I note that the consumer pages of the PDR (www.pdr.net) did not have a listing for Nexium. All of the information available was from the manufacturer.

Professor Bernstein, Direct-to-Consumer advertising received a mixed review from our group discussion in MPTX 512. The pitfalls of self-diagnosis were seen as an ongoing issue with this type of advertisement. The positive viewpoint on this type of advertising noted that sometimes doctors might not be aware of a new drug on the market. Also, if patients are "inquiring" about the new drug and it is not currently on the doctors/hospital/clinic formulary, the additional input form the public might enable the drug to become accepted into the formulary more quickly.

During an in class discussion (in Dr. Frances Richmond's class) on this issue two main views were formed regarding direct to consumer prescription advertising. One view suggests that as long as the prescription drug advertising is not misleading to consumers (i.e. advertisements communicate adequate risk information to patients), then the use of the ads will provide needed patient eduation. However, even if the risk information is presented, it is frequently printed in small type and the information is taken verbatim from the approved package insert. Since the package insert is written for health professionals, it may be difficult for consumers to understand exaclty what the risks may be. Another view suggests that direct to consumer advertising will cause patients to attempt to self treat and as a result. consume too much of physicians' time demanding treatment that may otherwise be unnecessary. In short, the patients will be labeled as "out of control".

Melina McDaris Dass

mcdaris-dass_melina@allergan .com