Anyone who watches television or reads popular magazines knows the amount of money spent on advertising for prescription drugs has increased dramatically in the past few years. We are practically inundated with ads for the latest new drugs for heartburn, allergy and pain relief, and what we’ve all learned to call “erectile dysfunction.”
Considerable attention was focused on direct-to-consumer (DTC) advertising of prescription drugs in January at a special meeting in Chicago of the National Association of Attorneys General (NAAG) on “the costs and benefits of prescription drugs.” Critics of the drug industry said money spent on such advertising is wasted because the ads have little or no educational content and most consumers are too ill-informed to understand real data.
One speaker at the January meeting, Arnold Relman, a retired Harvard Medical School professor, even floated the idea that prescription drug advertising ought to be banned, or at least banned from television.
Doctors’ Judgment Disparaged
Marketing by drug companies to physicians was similarly attacked at the meeting.
Speakers disparaged the ability of physicians to make informed choices, and said giving doctors free samples was “stepping back to the dark ages of medicine,” since it implied a trial-and-error methodology instead of the double-blind clinical trials that are the “gold standard” of medical research.
Medical doctors have “no scientific training,” said Relman, and thus cannot be trusted to enroll and supervise their patients in clinical trials. He implied that many doctors have become, unwittingly or otherwise, marketers of the latest and most expensive products of the drug companies.
Promotion Necessary for Survival
The economic reason for the proliferation of drug ads is a race against the clock by drug companies hoping to recoup their investments in research and development before their patents expire, at which time cheaper generic drugs flood the market.
New drugs typically require 12 years or more to go from laboratory to pharmacy, while patent protection typically expires after 15 years. This gives a drug company just three years to earn enough to pay not only for testing and production of that specific drug, but also to recover the cost of all the drugs that didn’t make it through clinical trials or that faced tough competition when they reached the market.
Only one drug of every 5,000 that are developed and laboratory-tested ever reaches the market.
Ed Slaughter, director of advertising and trends research for Rodale, Inc., and Dan Troy, former chief counsel for the Food and Drug Administration (FDA), defended DTC at the NAAG meeting. Both commented on the paradox of self-proclaimed consumer advocates calling for giving consumers less, rather than more, information upon which to make decisions.
No one forces a person to buy a prescription drug, Troy noted. All advertising can make you do is ask your doctor about the drug.
Slaughter’s survey research showed only 7 percent of adults report having asked their doctors for an advertised medicine (93 percent did not). Surprisingly, this figure has remained unchanged since 1997, “despite a nearly 300 percent increase in spending on DTC advertising.”
DTC is effective at reaching people unlikely to read medical journals or other sophisticated sources of information. According to Slaughter, the ads also serve as a source of information about prescription drugs taken by friends or family members, and about drugs people are already taking.
Drug Ads Highly Regulated
John Calfee of the American Enterprise Institute pointed out that hospitals are not required to disclose health risks in their advertising, even though those risks are known to be many times larger than the risks disclosed by drug companies in their ads. Relman acknowledged this and said he hoped hospitals could be coaxed to disclose more such information.
Scott Lassman, assistant general counsel for the Pharmaceutical Research and Manufacturers of America (PhRMA), noted drug ads are already much more strictly regulated than ads for other consumer products.
A practicing clinical endocrinologist, Richard Dolinar, was at the NAAG meeting to reject, with passion as well as common sense, the claim that doctors are easily manipulated by drug companies or should somehow be protected from the insidious temptation posed by free samples.
Dolinar spoke of the tremendous hardship imposed on his patients by government regulations, how useful it is to get information from drug company representatives, and how insulted he felt by the implication that he and his colleagues are “on the take.”
Doctors Bear Responsibility
The most compelling message on advertising and marketing came during the question-and-answer session at the end of the conference.
Relman, who had been so critical of the ethics and training of doctors in earlier remarks, stressed that the solution to the problem rests entirely in the hands of the profession. “There is nothing policymakers can do about it,” Relman said.
Doctors, he said, need to take greater responsibility for their journals, training, and enforcement of ethical standards on members who accept free samples and drug industry dollars.
That is a message with great consequences for everyone–government officials, consumers, and, of course, doctors.
Joseph L. Bast ([email protected]) is president of The Heartland Institute, coauthor of two books on health care reform, and publisher of Health Care News.
For more information …
A 54-page collection of essays addressing prescription drug regulation, distributed by The Heartland Institute to state attorneys general and speakers at the January 2005 NAAG meeting, is available online at http://www.heartland.org/Article.cfm?artId=16267.