Doctor, i'll take over from here...
I listened to an interesting panel discussion today at the Academies regarding Direct to Consumer advertizing. Direct to Consumer advertizing, or DTC, refers to how pharmaceutical companies market their products directly to patients via radio, television, and print media. Instead of recapping everything i heard, i thought i'd just share a couple thoughts (i do have independent thoughts, occasionally).
First of all, the whole notion of advertizing prescription drugs to patients seems absurd. Whereas nearly all ads target a consumer who wields the power to determine whether or not they will purchase the product, these drugs are being marketed to patients who technically have no say in whether or not they will ultimately purchase the product from the companies. instead, doctors must first prescribe the medications before patients can pour absurd amounts of money down the pharmacy's throat.
now as you can see, there was a 'technically' included in that last point. the speakers described an academic study that explored the impact patients had upon their doctors, and how advertizing played into the ordeal. the study consisted of a few hundred actors, all of which pretended to exhibit the symptoms of depression/adjustment disorder. Upon visiting their doctors, a third of the actors didn't ask for any medication, a third asked for medication without specifying, and the last third requested a particular medication (in this case, paxil). All the patients had identical symptoms, yet those who asked for medication were much more likely to receive medication, and those who specified paxil were much more likely to be prescribed paxil than those who didn't specify.
the moral of the story is that patients are influencing the diagnoses of their doctors and playing a part in if/what drugs are prescribed. This is wrong. If people were knowledgeable enough to diagnose their own illnesses, then we wouldn't need doctors as intermediaries. the reality is that watching a 30 second commercial that 1) convinces you that you do have a problem, when you may or may not, and 2) enlightens you as to how their product might remedy that problem DOES NOT equate with seven years of medical school plus residency.
Although i can understand the difficulties with keeping abreast of the values/risks of newly introduced drugs while still maintaining a bustling schedule, the task must ultimately fall upon the shoulders of the medical community to determine whether or not they prescribe a certain drug. This should be ingrained deep in the mindset of medical students, and once granted their license to practice, there should be obligatory seminars at established intervals wherein doctors must attend and learn of any new medicines pertinent to their field, or any new information concerning those medicines already in circulation.
DTC plays only a peripheral role in the grand scheme of pharmaceatical advertizing. Roughly 4 billion will be spent on DTC in the states in the next fiscal year, while a total of about 25 billion will be spent by pharmaceutical companies advertizing their products (other forms include sampling, medical journal advertizements, etc). still, that money isn't negligable. i think it should be redirected (the US is one of two countries in the world that allows DTC Rx ads...New Zealand will most likely ban it in the near future) to informing the medical community more effectively so we can rely on our doctors to know what we need. as far as people being concerned about their own well-being, i think hypochrondria has established a firm foothold in our society and won't be waning anytime soon. so fear not, if somebody's depressed and the television commercials disappear, i don't think we'll see an enormous dip in trips to the psychiatrist.
now the question about how drug companies are allowed to market their products directly to doctors is another crucial issue. should there be limits on spending? should somebody (the federal government, medical oversight bodies) fund this advertizing so that everyone gets an equal say? how do they determine who gets a say in the first place? all questions for another time and another blog.
all i know is that a medicine should be weighed on its medical benefits, and not the sexiness of a marketing campaign.
8 comments:
I was also at the seminar that Phil mentions. I think DTC has some positives and negatives- I'm not entirely against it. I think it useful in introducing patients to new medicines that might night otherwise know about, especially those that are treated for ongoing conditions.
Even though the doctor ultimately writes the prescription, he/she writes the prescription based on what the patient says about his or her condition.
For instance, I am treated for migraines. The doctor writes me prescriptions based on long, detailed conversations with me about my condition. Occasionally he will write me a prescription for a new medicine- sometimes it is one I've asked about and other times it's one he's suggested. Since I've started my migraine treatment, all types of new drugs have come on the market. So we are always looking for a new, better treatments (but we end up coming back to the original one anyway).
My point is that doctors, in the end, write the prescriptions. However, it is, and should be, in consultation with the patient. Good doctors would never write a prescription for something they don't believe would work for a patient, especially if the patient tells them that. DTC isn't a negative if it can help introduce new, and potentially better, treatments for pre-existing conditions.
hey judy-I had to battle through this issue a little bit because i can understand your argument defending the benefits of DTC.
my complaint is that patients might distort their symptoms to match those listed on a commercial. If somebody sees a commercial rattling off the symptoms of depression that offers a panacea for the ailment, then a guy sitting on his couch might attribute his anxiety and sexual problems immediately to depression. hell, there's a pill that will cure his woes...doesn't really matter if he doesn't experience low energy, clouded thinking, etc. (other tell-tale signs of depression). his problem vaguely matches those presented in the commercial and, in his mind, he's found a way to remedy his issues. Self-misdiagnosis seems an insurmountable hindrance to the productivity of DTC.
Instead of advertizing prescription drugs to patients, we need to find a better system for 1)ensuring that doctors know the ins and outs of medications in their respective fields, and 2)motivate patients to analyze and describe their conditions more accurately. the latter shouldn't depend on drug companies. instead, it should be incorporated into elementary and secondary health education courses and discussed more openly in the media.
the other critical element of facilitating dialogue about health involves destroying the stigmas that accompany debilitating ailments...only then can we communicate about these problems without the fear of being socially ostracized. television, and reality-type shows in particular, could take a lead in accomplishing that feat.
SUMMARY: i agree with you that we need educated patients, but they shouldn't be instructed by drug companies that have a financial stake in the matter. They should be taught by someone who has a stake in their health.
I have to agree w/ you on this one, PD. My comment is two-fold.
1) I agree that those w/ ailments might tailor their symptoms to those mentioned in a commercial and that this presents a problem. The other troublesome tactic used by drug companies is to just advertise the drug itself, its name only, without ever telling the consumer its purpose. These medications get asked for by patients almost as often, just because something about the commercial - the colors, the voice describing the drug, etc - was provocative! Crazy. Just think about the 'little purple pill' campaign - how many people know the purpose of this pill?
2) From my standpoint, medical education is doing a great (I thought about the word choice there) job keeping students up to date on new meds. Students learn the basics of all drug classes in pharmacology, and then are provided w/ updated references. It is a requirement, in Jason's program at least, that each student have a PDA going into their clinical years. The programs they can download or link to through these guys are phenomenal. Personally, I think this is the fastest way to stay up to date - everytime Jason links his PDA to his laptop, updates for these programs (including new drugs and drug interactions) are automatically downloaded. Here is an extremely positive use of technology, yes?
Hey MP-Is Reno matching up to the Caribbean these days?
Thanks for your input, it's good to have a med-school perspective (not quite once removed). I find it heartening to hear about the PDA update technology used in Jason's Rx courses. I'm guessing they're also tested to ensure they've digested the most current information? It makes me think the first critical steps have been, or are being, implemented in the medical schools.
I'm still worried about what happens when they complete their residencies and start their own practices. How do we ensure that our doctors know the latest information about medicine. What metrics evaluate the continued competency of a practicing doctor, and do they go far enough in this exponentially-increasing pharmaceutical category?
I don't want to sound like I'm demonizing doctors here. Especially with the managed care structure, doctors have to load their schedules to see an inordinate number of patients. How much time does that leave for them to stay updated on new medicinal developments?
What about something like this: a drug company that wants to market a drug has to pay a 'fee' to a centralized medical body/board. that fee essentially consitutes the money they would pour into DTC. Said funds channel into two places: 1) the information about that new drug is included in a booklet summarizing new Rx info in a particular medical field. This booklet is disseminated to doctor's in that field, which serves to prepare them for some kind of 'update' examination required every few (3-5?) years (kind of like updating a license, except the elder people-my grandpa-that shouldn't be driving don't get renewed so easily). 2) those funds help to cover the expenses incurred by doctors for preparation and test taking.
everybody wins. The drug companies have their product names circulated among the medical community, medical practicioners stay abreast of the latest developments without going broke or insane, and patients rest assured their doctors understand the most suitable avenue of pharmaceutical treatment. it seems to me like this is a more optimal structure. Obviously we'd have to iron out the logistics, but i think something like this is a better starting place.
Perhaps something like this exists and it just requires fine-tuning/modification?
1. it seems logical that docs would want to be knowledgable about the meds they're prescribing and that they would be up to date with the latest and greatest. however, consider that docs are super busy. often seeing way more patients a day than is appropriate (in my mind--how well do these docs really know their patients? have they built a relationship with their patients that gives them some insight into what is truly going on? ie psychoses, hypochonriasis, true "medical" issues, etc). Also, many docs rely on the info supplied them by drug reps...they get free samples, free pens, free meals while sitting and listening to reps describe the wonder of the new drug. There are studies that show docs tend to prescribe these particular drugs more often than others...(wish i could remember the name of the study...sorry).
2. another interesting point: docs prescribe more than drugs. they also prescribe items that I, as a pediatric physical therapist am qualified to determine that my patients need... wheelchairs, walkers, orthotics, bathchairs, etc. Interestingly, insurance cos do not allow PTs to prescribe these, there has to be a script from an MD. Usually, the doc knows hardly anything about these pieces of equipment or why they would be helpful for the kid. I have to jump through hoops: request a script from the doc, submit it to the insurance co with a letter of justification (that I write, not the doc), and hope to god they see fit to give my kiddo (with cerebral palsy who can't sit independently and randomly goes into extreme spastic extensor tone) a wheelchair. sorry about jumping on a soapbox, but sometimes our med system just doesn't make sense.
hey Bren-soapboxes welcome and encouraged. I don't feel like i need to add much. i agree with both complaints: doctors, in general, see too many patients and seem too easily swayed by nifty marketing campaigns. I do think drug companies deserve some monetary rewards for sponsoring important research. however, the patent period should cover this priveledge. they shouldn't (most companies benefiting from DTC and sampling to doctors are the huge pharmaceutical companies that produce the original, not the smaller companies marketing duplicate drugs after the expiration of patents) continue to receive special treatment when their particular drug is either more expensive or less suitable than another option.
That's interesting about the various PT accoutrements that require an MD's clearance. I see your frustration. Anything being done to remedy/change that policy?
you spelled advertising wrong
you spelled advertizing wrong
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