Monday, October 29, 2007

What's Wrong with DTC Ads?

According to the Wall St. Journal's Health Blog, John Edwards is calling for a two year post-approval ban on direct-to-consumer drug ads. Having stayed up for the past several nights watching my team win the World Series, I have certainly received an excessive dose of DTC ads for the likes of Cialis, Flomax, and Lipitor (is anybody else creeped out by Jarvik as he cocks his head and bats his baby blue eyes?) And, yes, I get that DTC's encourage consumers to ask their doctors to prescribe the newest and most expensive meds.

But banning them doesn't make sense. Why? For one, it's one of the only arenas where drug companies advertise their products with full disclosure. Everybody knows it's an expensive ad paid for by the company. There's no pseudo-legitimate journal or medical education company pretending to be a scientific article, when in reality it's a paid advertisement.

Second, they do serve an educational function for consumers, if biased. There are a lot of guys out there urinating very frequently who would not consider this a potentially treatable issue if they hadn't seen those irksome Flomax commercials, the ones featuring the sports-crazed baby boomers who get to hang out in their kayaks longer without having to run into the woods--all because they're taking their Flomax. Sure, viewers are going to run to their doctors and ask for Flomax my name, but it's up to the docs to decide which drug is best. And meanwhile, some men will find out they have early prostate cancer (rather than benign prostatic hyperplasia) and might get their lives saved in the bargain.

I say let the companies have their DTC ads, and use the extra money they gain from increased sales to fund a government-administered pool of money to pay for unsponsored continuing medical education. This will save the health care system much more money in the long run.


Anonymous said...

I'm shocked that you are pro-DTC. Don't you think that DTC ads pretty much inflate the demand for patent drugs? And "they provide education, although biased." I thought you're whole complaint about PHARMA is that they provide biased information. But here it's okay?

Daniel Carlat said...

I draw a line between legitimate and fully disclosed advertising, and advertising cloaked under the guise of CME. I believe advertising is fine, but commercially-funded CME is corrupt.

Anonymous said...

Since the FDA gave the go-ahead for televised DTC advertising in 1997, the results have been ... well ... let's just say—confusing.

Sometimes, even the positive aspects of DTC ads have mixed consequences. For example, study-after-study has concluded that patients who request a pharmaceutical from their doctor after seeing an advertisement are much more likely to be fully compliant (at the start) with their doctor's dosing instructions—a good thing. However, perhaps, and/or because the treatment was the "patient's idea" so-to-speak, it has been noted that these same patients—after time—feel they have license to unilaterally adjust dosages, or even quit the drug outright w/out physician notification—a bad thing.

Another questionable result of the DTC "revolution," is the fadistic emergences of diseases de jour, such as bipolar and ADHD, which have grown well beyond the bounds of statistical epidemiologic probability.

As a general comment, I would like to applaud Dr. Carlat's open-mindedness about the possible benefits of DTC advertising. Maybe, like the song, consumer advertising will keep getting better all the time. We can only hope that is the case, since DTC is most definitely here to stay—whether you or me or Senator Edwards likes it or not. The world has not seen the terrifying level of lobbying that will descend on Washington from the likes of CBS, NBC, and ABC et al., should anyone dare to limit drug ad revenue.

As always, good luck to all of you on the front lines. You're gonna need it.

Anonymous said...

By the way, Danny—congrats on the Red Sox win. As someone who doesn't care for baseball, I was more interested in the Cialis, Flomax, and Lipitor ads (which you reference on your blog) than the games. And even here—there is a lesson for Big Pharma's future DTC success.

Coincidentally, the World series was an excellent example of how the drug industry wastes millions of $$ on DTC advertising. How could anyone possible care about—or even remember—seeing a Flomax ad after watching the brilliant (and numerous) 10-second spots for the beer brand, Dos Equis, titled "The Most Interesting Man on earth?" (Please take a moment and watch this. Now I finally know what I want to be when I grow up!)

Flomax, Shlomax, Glomax ... give me a Dos Equis. Stay thirsty my friends. —jlr

PharmaGuy said...

Jarvik freaked me out from the first time I saw him -- see "Lipitor's Jarvik: Fop or Flop?"

Anonymous said...

DATSWHATIMETAWLKINGABOUT! You wanna sell Buster Brown loafers—Doc Jarvik's your man. You wanna sell Lipitor—doggonit—that's a job for the Dos Equis man. You take the Lipitor; you take some bar nuts, and you make a Lipitorcrunchbar. They'll be such a run on the stuff that Pfizer will be passing out artificial hearts stuffed with jelly beans at hockey games.

Fop or flop aside, though, my guess is that Jarvik is having the last laugh as he sails the Caribe, sans purple tie, while I sit here worried that my kids will find out what a good time I'm having in the middle of my work day when I should be grubbing for their tuition money...

ps—Great picture, John! That's the best Halloween costume I've seen all day. Cheers.

blog deleted said...

I've never seen an argument for allowing direct advertising to consumers before, much less one this strong. Thank you.

I agree that some advertising may be beneficial to raise awareness about a condition, but whether or not advertising fits the bill is another question entirely.

I'd say allow companies to create ads about a condition which they make a drug to treat, without allowing them to use the name of their medication in the ad. Give them a small tax-write off in the process. (Kill two birds with one stone: reduce demand for a new patent drug while still educating the public, and reduce the not-so-legitimate "write-offs" most big Pharma companies give themselves).

Anonymous said...

Dr. Carlat:

As always, an interesting post.

We here at Prescription Access Litigation don't see any net benefit to DTC - 'biased' education is, well, biased -- there's no meaningful way to eliminate the negative effects of the bias. Do we want men to see their doctors about prostate enlargement? Sure, of course we do. But is DTC the only way to achieve that?

We give away too much by presuming this is so. The message of the Flomax ads is not "see you doctor about your urinary issues, and discuss a variety of possible treatments." The message is "see you doctor, and ask for Flomax," with an implicit message that if your doctor doesn't prescribe it, you're somehow not getting "the best" treatment available.

Why can we not instead select the the most serious and prevalent untreated and undertreated conditions, and launch a campaign of genuinely "public" Public Service Announcements for them? By "public," I mean not funded by any company with a vested interest in a particular treatment?

You could fund such ads with a portion of say, pharmaceutical user fees, or just earmark a line item in the budget of any of a half dozen federal agencies -- FDA, NIH, CDC, AHRQ, even CMS -- certainly there's a huge public benefit increasing treatment for many underdiagnosed conditions that would more than pay for any cost of these ads, which would be minimal.

Finally, if DTC is a necessary evil to educate consumers about particular conditions, are those conditions significantly more undertreated in countries without DTC? If the answer if NO, then DTC is not a necessary evil.

Daniel Carlat said...
This comment has been removed by the author.
Daniel Carlat said...

It's a complicated issue, and there are good arguments on either side. In an ideal world, I agree that we would have unbiased publically funded ads to educate the public. However, the harsh fact is that a 30 second spot during the World Series costs $400,000 and we have to wonder whether we can afford it, especially when drug companies are more than willing to foot the bill. Pragmatically, we have to choose our battles. I believe that getting doctors honest is the most crucial front line.

Anonymous said...

"I draw a line between legitimate and fully disclosed advertising, and advertising cloaked under the guise of CME. I believe advertising is fine, but commercially-funded CME is corrupt."

Oh please, what's the real difference? One is aimed at patients while the other at physicians. presumably, physicians should be more educated on the topic, and thus, able to discern the bias. But you seem to think otherwise. But with DTC the target is an uneducated public. Does "disclosed" mean anything to that population?

I think there's a bit of snobbery going on here with your views. You just don't like physicians being manipulated. When it comes to the public, I suppose you think since physicians are "gatekeepers" it's okay. Does anyone else see the flaw in this logic?

Daniel Carlat said...

Getting a little snarky, aren't we? It looks like we have a difference of opinion on the issue--I don't see how the snobbery piece is helpful.