The TV knows stuff about you. It's not as much as Facebook, of course, but it knows that if you're home during the day, there's a higher chance you're disabled or retired. Or if you're up at three in the morning, there's an increased chance you're unemployed. It knows the general area that you live in, but it doesn't know you from your neighbors, at least at this point in media history. The TV doesn't know your health history, the results of your latest blood workup, your BMI, cancer staging, HIV status, drug allergies, sexual relationships, or even just how you're feeling these days. This is a good thing.
That list is, of course, a bunch of stuff that your doctor is likely to know. Even if you're doctor is crappy, they still probably know a lot of this information. It's information that they use to come up with good diagnoses and, then, treatments, which may include prescription drugs. The weird thing is that ads on the TV (or in magazines or on the internet) are also pushing prescription drugs, making diagnoses, suggesting (to put it lightly) treatments. This is called direct-to-consumer marketing, and it's illegal in every developed country save for New Zealand and the United States.
Which makes sense, given that it's bad for everyone involved except for people selling drugs. Doctors are likely to prescribe the drugs that patients request based on being advertised to for the simple reason that if they don't some other doctor will. You could argue that the drug-patient-doctor triangle is only as good as the sketchiest doctor currently accepting new patients. So, the risk is overuse and misuse of drugs. Ads also push patients toward brand-name drugs, e.g. the same thing as generic drugs but way more expensive. Which is all bad for everyone, or at least anyone that pays into the health care system (through taxes, insurance premiums, whatever).
Moreover, diagnosis via advertising raises drug prices for everyone simply by inflating demand. A 2010 paper estimated an overall 1 percent average increase in drug prices due to DTC marketing. One might safely expect that increase to be locally higher for big ad spenders like Allegra or Lipitor, or the various boner drugs being pushed. Determining the exact amount of price inflation is pretty tough, however. A really good number would require a lot of super-invasive questions on subjects including boners and late-night TV viewing habits.
One might also imagine DTC inflation rippling outward through the health care system, as ads drive patients to see doctors that might not really need to see for symptom they hadn't really considered until having them insisted upon by some ad. A good determination of the drug ad ripple effect would be even harder to estimate well.
The DTC situation just gets worse. A report from the WHO explains:
Direct-to-consumer advertising is also blamed for encouraging so-called off-label uses of drugs; that is to say uses not approved by the FDA, the USA regulator. An example of this would be gels and fillers that had initially been approved by the FDA as dissolvable sutures that are being promoted as scalpel-free alternatives to cosmetic surgery. For Professor Alexander Capron, University of Southern California (USC) Gould School of Law, the use of direct-to-consumer advertising in the promotion of off-label uses has been if anything, “a more slippery slope”, than aggressive or misleading promotion.
If you're old enough, you might remember when drug advertising had to list side effects, either scrolling on the screen or read out lout. Remember "Happy Fun Ball" or, more recently, Dr. Funke's 100% Natural Good Time Family Band? Yeah, that's where those jokes came from. This changed in 1997, when the FDA relaxed its rules for direct-to-consumer advertising to, basically, "side effects? what side effects?" In just the five years following the change, DTC spending increased from about $800 million a year to $2.7 billion. In the same period of time, drug spending increased by 86 percent, according to a Kaiser Family Foundation report. Half of that is attributable to an increase in the base number of prescriptions being written.
The drug industry in the United States currently operates according to the myth of self-regulation. The Pharmaceutical Research and Manufacturers of America issue guidelines and drug advertisers, the association's membership, are supposed to abide by them. Those guidelines exist less because the drug manufacturers of America are all awesome and very deeply concerned about the issues surrounding direct-to-consumer advertising than to keep the FDA from deciding it wants to catch up with the rest of the Western world and ban a thing that is categorically bad for American health care consumers, e.g. all Americans.
So, how is that all going, the self-regulation? Not so great, according to a study out today in the Journal of Health Politics, Policy and Law that focuses on erectile dysfunction drugs. The study, written by Denis Arnold of the Belk College of Business at UNC Charlotte and Montana State University's Jim Oakley, goes as far as to call DTC self-regular "an industry-sponsored ruse." Ka-pow.
Here's the summary:
- Advertising for ED drugs grew from $200 million in 2006 to $313 million in 2009, a 56 percent increase. Television advertising accounts for about 80% of the DTC ad spending.
- There was a clear pattern of non-compliance to the "Guiding Principles" for the three drugs under study, and Arnold and Oakley note that PhRMA does not make public violations of its guiding principles, nor does it sanction member violations.
- Eli Lily's Cialis campaign consistently violated six principles, partially complied with two principles, and fully complied with one principle.
- Pfizer's Viagra campaign consistently violated five principles, partially complied with one principle, and fully complied with two principles.
- Bayer Healthcare, GlaxoSmithKline, and Merck's Levitra campaign consistently violated five principles, partially complied with three principles, and fully complied with one principle.
- In the four-year time span studied, there were nearly 100,000 television advertising occurrences for ED drugs.
- American consumers have been exposed to approximately 500 billion ED television advertising impressions since 2006, of which over 100 billion were seen by consumers under the age of 18, in violation of the Guiding Principles.
- Patient information and print ads were consistently found to exceed recommendations for consumer legibility violating the Guiding Principles.
- Each of the drugs is presented in ads as the most appropriate first stage treatment for impotence, despite known risks such as priapism and sudden loss of hearing or vision. - None of the ED drugs effectively informed consumers of alternative options for treatment, in violation of the Guiding Principles.
- The mechanism set up by PhRMA for consumers to make complaints does not function: the FAX machine is typically not connected and complaints go unanswered.
"Cumulatively, our data shows that ED marketing campaigns fail to responsibly educate consumers about health conditions and appropriate treatments," Arnold says. "Instead of facilitating a balancing of interests between company profits and public health, the illusion of industry self-regulation is primarily serving the interest of pharmaceutical companies at the expense of the public's interest in genuine health education and welfare."
But maybe there's a convergence looming. Maybe, instead of cracking down on DTC marketing, we just need to make sure advertisements become better doctors. You know, just stick your arm in this hole for a blood draw, enter your vitals on this screen, etc. "Sorry, this channel is unable to accept your insurance coverage. Proceed anyway? Yes/No."
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