Clarifying my views on pharmaceutical advertising

Another excellent blog published 2 interesting commentaries on a recent post – Direct-To-Consumer Advertising

To those of us who understand the power of the free market, it comes as no surprise that actually advocating for freedom, in this instance the freedom to advertise to your consumers and the freedom as a consumer to find information, will help the market match the patients with the drugs they need. For physicians to ask the government to give them a total monopoly as the information gatekeeper (they already have successfully established a role as a prescription gatekeeper) will be harmful to the patient/consumers for which they are supposed to advocate.

This quote ends a very interesting and long rant from Trent McBride. He argues (and I give my interpretation) that DTC advertising enhances a free market. That might work if patients paid for their own drugs. However, as long as we have 3rd party payors involved, the patient has no incentive to consider price in their decision. Some patients do, and those patients generally make that clear to their physicians, or they just do not fill their prescriptions.

The problem that I have with DTC is not a free market argument, but rather the impact on the doctor patient relationship. While working out this morning, I saw an adverisement for Enbrel (etanercept). This drug does represent an important advance for some rheumatoid arthritis patients. The problem that I have is that while I understood the ad, the 2 intelligent women working out in the same room started asking me questions about the ad. It took over 5 minutes to put the ad into perspective.

If we could charge patients for the extra education, then I could support these ads as stimulating an educational exchange. Unfortunately, unless one runs a cash only practice (charging by time periods), or retainer medicine, then the extra time has a negative impact on ones practice.

Unintended consequences

In the era of the internet, patients are becoming increasingly savy about obtaining medical information (including drug info). The days of medical paternalism are diminishing, as patients are now much better informed, and want to have a say in the medical decision making process. We can regulate DTC advertising, but I don’t think that it will make the genie go back in the bottle.

Galen equates internet information with DTC. I would gladly debate this issue. Advertising has several purposes, but branding is (I believe) the chief purpose. If a patient comes in with should pain and asks for Celebrex, and I suggest OTC Advil, is the patient satisfied. Patients are very susceptible to branding. They want the drug they saw on TV (and I will not even discuss the Viagra and Cialis ads).

If we want responsible pharmaceutical use, then we must remove advertising from the equation. Choosing a drug is too important to let advertising influence our decision making. I believe this true for both patients and physicians. We need unbiased information sources – and advertising is never unbiased.

So I will disagree with these two thought provoking posts. I ask the authors to continue the discussion, as our continued debate will help delineate the issues, clarifying our understanding and beliefs.