Volume 16, No. 3, Summer 2008
Is the television barrage of “ask your doctor about…” drug commercials driving you crazy? Well, if you want to escape, don’t go to New Zealand. That’s the only other country in the world that allows such advertising.
It wasn’t always so in this country, either.
But, conceding the annoyance factor, has the introduction of this type of Direct To Consumer advertising provided a public service? To Your Good Health, A Healthcare Newsletter, broached this issue at the most recent meeting of its Advisory Board at Cape Cod Community College.
Dr. William McDermott, a retired Navy physician and former Executive Director of the Massachusetts Medical Society, provided some background.
“It all started about 30 years ago and 25 years ago I was invited to participate in an American Medical Association panel to address this issue,” he related. “We were very concerned about it then and I remember taking a very strong position opposed to it, as did most of organized medicine. That’s because it infringes on the practice of medicine by providing information in a way that is probably dangerous and at the least biasing people toward using certain pharmaceutical products that they wouldn’t have been using. I was against it 25 years ago and I’m against it today.”
Dr. Arthur Bickford, co-founder of the Duffy Medical Center, sees another negative to prescription drug advertising. “You begin the discussion not about what causes your condition, but with the treatment and that’s the wrong end of the street,” he pointed out. “I would respect them more if they talked about things like exercise and salt restriction.”
Dr. Herbert Gray, head of the Falmouth Hospital Emergency Department, agreed. “Those statin ads should show a picture of what a clogged artery looks like rather than someone running through a field of daisies. They should talk about lifestyle changes (first), rather than medication.”
“The drug industry is just like any other industry, they’re all just trying to market their products,” said Denise Dever, president of HomeInstead Home Care.
As Dr. Kathleen Schatzberg, president of Cape Cod Community College, summed up, with the addition of the Internet where one can read about and even order drugs from sometimes mysterious sources, “It’s like the wild west out there.”
How did all of this come about?
According to David W. Rehm, new president of Hospice & Palliative Care of Cape Cod, “This is a fundamental public policy issue and the withdrawal of the FDA (U.S. Food and Drug Administration). The government is backing out of this issue, deregulating the whole healthcare market just like we’re deregulating utilities.”
Despite what the drug companies claim, “It’s not education, it’s misinformation in many ways,” Mr. Rehm charged.
“The FDA has dropped the ball,” agreed Peter Scarafile, chief of the pharmaceutical department of Cape Cod Hospital. “There is less and less review and there’s no way this advertising can be considered ‘education.’ We’re just leaving it up to the drug companies to control the message and the primary reason they’re doing it is to sell drugs.”
Mr. Scarafile said pharmaceutical companies in this country spend $30 billion annually on advertising, 20 percent of it, $6 billion, in so-called Direct To Consumer vehicles such as television.
What can be done to mitigate industry influence?
Monica Mullen, an aide to Senate President Therese Murray, said current legislation is aimed at outlawing drug companies’ frequent practice of gifting physicians with free meals, trips and other expensive incentives to promote their products.
And Mr. Scarafile added that Cape Cod Hospital is planning to join many other hospitals in limiting the access of so-called “detail” salespeople “with their free lunches and pens,” and allowing them only to discuss already-proven drugs.
“We also could control it to a certain extent with our pens by not prescribing the drugs,” Dr. Gray suggested. “We have to re-educate our patients about alternatives, more cost effective measures or medications that already have worked and resist changing someone’s medication based on their pressure to prescribe it. The trouble is, most primary care physicians are so busy they don’t have time for this….or to do their own research on new medications. Those ads can be the ‘back door’ to the doctor’s consciousness.”
If physicians resist prescribing the TV drug-of-the-day, companies on their own may scale back advertising that doesn’t work. “Don’t give them a return on their investment,” he said. “If nobody’s buying that purple pill for their stomach, sooner or later those ads are not going to show up.”
And Mr. Scarafile did note that some recent studies show that these ads may be growing less and less effective.
Still, the contest may be difficult if not impossible.
“Drugs are coming in from all over the word, including generics, and there is tremendous competition to sell pharmaceutical products,” Dr. McDermott said. “These companies are in business to make money and the essential activities of business are innovation and marketing. Much as I hate it and despise it, you will never, never stop it.”
“Innovation does drive U.S. industry,” Andrew Young, a former trustee of Cape Cod Hospital agreed, but he countered that other forces might help temper the industry’s free-wheeling approach. “Medical insurance already is limiting what drugs can be prescribed,” he pointed out, “And, like bans on advertising promoting cigarettes, there are now some by-products that could be having public health effects. With so much public funding for health care, soon it may affect drug advertising as well.”