I saw a commercial for a chemotherapy drug last night. That was a first.
I’ve seen quite a few - mostly for lung cancer treatments. In one, they specifically say “actor portrayal” (well, cuz the actual patient looks too sick to be seen on TV, I imagine… or she died already because the stuff only bought her a month or so).
The ONE example I can think of where DTC advertising might have actually done some good: when Requip was approved for treating Restless Legs Syndrome. As a long-time RLS’er, I already know of that class of meds - but it’s such a strange condition that gets chalked up to “you’re imagining it”… so for this one, sufferers were finally able to see that there really IS something going on and it might be treatable.
It turns out, the companies are spending FAR more on advertising than on R&D :mad:.
So, yeah, us 'Mercans are not only subsidizing the rest of the world’s drug prices, we’re subsidizing advertising agencies too.
That’s not actually so.
And I’m fairly sure one of those countries (hint: Not the US) has rules or codes of conduct around how it is done.
When I lived there, I recall ads for medicine but they were almost never on TV, and they always had a strong undercurrent of “Hey, if you’re at the doctor discussing proxyglossariasis treatments, perhaps you’d like to mention you’re aware of this medicine’s existence and ask if it might be wortwhile taking it? Just a thought, no pressure.”
You can often spot the Australian and UK journalists on a work trip to the US because we’re the ones at the breakfast buffet saying “Did you see those hilarious medicine ads on TV last night?” 
Not directly - as in “100 dollars a dose, 10 dollars of which goes to provide this drug to poor people in Africa” but in reality that’s how it works out. I didn’t come up with that phraseology.
How The US Subsidizes Cheap Drugs For Europe | IBTimes ““U.S. consumers are in fact subsidizing other countries’ public health systems, at least with respect to drug pricing,” Jacob Sherkow, an associate professor at New York Law School, said.”
https://www.bloomberg.com/graphics/2015-drug-prices/: "“We can no longer sustain a system where 300 million Americans subsidize drug development for the entire world,” said Steve Miller, chief medical officer for Express Scripts Holding Co., the largest U.S. manager of prescription-drug benefits. "
If a company is trying to sell its drug in another country, and that country’s medical structure involves negotiating prices down to the bone, the company is going to charge more where it can to prop up its own profits. There is much less strict negotiation in the US so they charge more here because they can.
:rolleyes:
I meant the country I was referring to in that case wasn’t the US, not that the US didn’t have laws and regulations around marketing pharmaceuticals to the general public on TV.
That’s not how you phrased it though.
I see this reaction LOTS more than I see people “asking your doctor if Fuckitol is right for you.” But I can’t imagine that they’d spend what they do if they didn’t find the ads to have a positive effect on sales.
While in general and mostly, I hate DTC advertising, there have been a couple of exceptions. RLS, as already mentioned. Spinal stenosis - that “awareness campaign” did get a lot of people into their doctors for back pain that they figured nothing could be done for. Non-24 ads have given a couple of my blind patients new hope that maybe their sleep issues are actually resolvable…and if not, that at least it’s not their fault that they’re sleepy all day and awake at night.
Just last night, I saw one for Contrave, a weight loss drug. Now, like all legal weight loss drugs, it’s pretty crappy. People “may” lose “up to” an extra 20 pounds in a year, with diet and exercise, but probably won’t. Thing is, I noticed it was a combo of bupropion (Wellbutrin) and naltrexone. I have been putting off going back to the doctor for my Depression that’s been flaring for, oh, 10 years now, because I’m obese, and I just can’t stand the idea of going on an antidepressant and getting even fatter. That ad made me do some research, and I discovered that bupropion, and other drugs in the SNRI category, not only don’t make most people gain weight, but sometimes help people lose a little. So…made an appointment with the doctor. I’ll try my best not to go in demanding bupropion, but I will tell her that 1) my goal is to relieve Depression and 2) losing weight would be a welcome side effect and 3) gaining weight is an unacceptable side effect. I’ll see what she recommends.
So, I guess like many things in life…I hate it until it benefits me. 
The situation in Australia is that if you were to rock up to your GP and ask him/her for a particular drug, they’d laugh you out of the surgery.
Hence there is no advertising in Aus for prescription drugs. Of course OTC drugs are fair game and they are advertised far too frequently, everything from diet aids, to fish oil and other woo shit.
The jury is still out on whether fish oil can be considered “woo shit”.
Like anything else, it mostly comes down to why you’re taking it.
Exactly. And when you get to the chemist, they invariably say “Do you want the less expensive (ie generic) brand?” to which all sane people say “Why yes, yes I do!” (unless their doctor has specifically said only to use one particular brand).
In fact, I think a doctor here would be suspicious of a patient who showed up asking for a specific brand without a good reason (ie previous experience with it).
Allow me to rewrite that:
the US are letting pharmaceutical companies rape them up any hole those companies feel like going into (some are more energetic about it than others - hi Mylan!; many pharmaceutical companies don’t sell in the US at all), because Freedom. And that is the fault of those other countries which are refusing to take down their pants and bend over. How dare they!
I’ve worked for two pharma companies while they were in the process of having fun with US prices, I’ve seen the actual documents detailing the marketing plans, and the lobbying, and celebrating the victories. Neither of them even had research labs in the US.
If the advertised drugs are beneficial, and if the physicians are prescribing appropriately, then an increase in sales means more people are benefitting from treatment. But that’s a lot of ifs.
Ok, I am sorry to be harsh, but that is utter bullcrap.
First off, the links just go to 404 pages. Second, judging just from the quotes, this does not seem to be quality information, exactly. First one seems to be rather far outside of his area of knowledge, and the second one sounds highly biased. Of course, that is just judging from the little information there, but it might go some way towards explaining why their opinion diverges so much with facts.
Now, the facts. Why does the US system not subsidize drugs elsewhere?
Well, first there is the concept of markets. When a drug developer negotiates with a national system to provide a drug, the negotiation process is employed as a means to arrive at a price that serves the interest of both parties.
You will notice that this practice works well in other areas, and does not generally require what is essentially human sacrifice to move along. If you took the US entirely out of the equation, this practice, would still tick along happily.
Second, is the amount of money the pharmas take in on the US actually relevant to research, as your fist link seems to assume.? Well, the pharmas spend more money on advertising that research, so I don’t think so.
So what does the actual research say?
While the US spends more money on research per person than other nations, this seems to be in line with health care in general, where vast amounts of money does not improve outcomes. US spending does not translate into more discoveries.
The US system does not, in fact lead to a higher degree of pharmaceutical invention.
Higher US prices go to pay for more advertising, and better profits.
You can frame anything as acceptable or even beneficial if you include enough ifs.
There is absolutely no reason to “inform” nonprofessionals about drug choices they cannot possibly evaluate.
It’s medicine, not rocket science. At least when you arrive at the mechanic with this outlook you only get ripped off.
But the silly pedestal we put physicians on aside, informing nonprofessionals lets them know they have something going on that can be treated and is worth going to ask a doctor about. We ran into this a few months ago with a relative who was experiencing discomfort around a port installed for chemo. She just thought that was something she had to deal with. Doctors and nurses don’t ask about everything. And we don’t think of everything when they ask.
But we cannot possibly evaluate treatment and must place everything in the hands of our physicians!..Yet they’re the ones writing the scripts when we ask about an advertised drug. Are they doing harm when this happens? Good?
Medicine is probably more complex than rocket science, which is mostly straightforward physics and engineering.
And a mechanic can get you killed through mistakes or sloppy work.
Neither of which has much of anything to do with the lunacy of getting patients to run to their doctor to pressure/second guess/ignorantly browbeat them because they saw two old people walking happily through a field of flowers while soothing music and a crooning voice told them that Fukitol would make their life a paradise.
So you’re postulating that a drug with a multimillion dollar ad campaign is going to be an unknown to a practicing MD in that field? Right.
What it’s likely to be is something to be regarded with caution until the treatments s/he already knows about, with years to decades of proven results, are passed by as inappropriate or ineffective, and it’s worth trying something that just passed trials.
Unless the patient is a pushy old shit who knows anything new and advertised on TV must be better, and insists on that drug, and so gets it because the doctor has neither time nor inclination to argue and they might as well see how Fuckitol actually works on a patient in front of them, regardless of its sky-high cost (hey, Medicare is paying) and unsorted side effects.
Right. Doctors are no smarter than the rest of us, certainly not as smart as a rocket scientist, never get any updated information on new drugs and treatments, only use old drugs that are wholly ineffective because they don’t know better, and are grateful when patients who watch daytime TV all day come in to tell them about medical advances.
If you’ve got a shitty doctor, change. But if you’re in the camp that things doctors as a whole are part of Evil Big Medicine and can and should be second-guessed at every turn because patients are so much smarter (from their commercial educations and Googling)… you’re looking for the Horseshit Room. Two doors down, on the right. I think I saw a commercial for it.
And med school is where we sent the kids who couldn’t hack it at straightforward physics and engineering or chemistry school.
Then show me the harm. I’ve already personally experienced the benefit and would like to see actual harm.
Known doesn’t mean that they’ll ask. Known doesn’t mean the patient will ask or even go to see a doctor.
The above makes it sound like physicians don’t actually know how to prescribe appropriately. Or perhaps they do know but don’t do it because…reasons.
Every GP I’ve had spends a whopping 10-15 minutes with me. It’s certainly not hard to inform myself well enough to my time’s with out of it with a quiver of questions. They sure as hell don’t ask much. Certainly nothing about a litany of treatable conditions that know about through advertising. But now I know that if I ever experience whatever the fuck “restless leg syndrome” is or if I ever need boner pills, those actually are things to stop putting off an appointment for.
(snippage of subsets of this posting are my own editing and if I accidentally left something critical out, my apologies )
Well, if the drug companies did not feel that the advertising budget was, in fact, driving up sales, they wouldn’t continue to do it. Certainly the amount of time and effort spent giving promotional materials and samples to doctors seems to work - if there are 12 different drugs to treat a condition, and the doc has just heard a sales pitch for brand A, that may well be the one he thinks of first off when prescribing for a patient. ESPECIALLY if he has samples of it on hand.
I would love to see if there are studies showing whether direct-to-consumer advertising did in fact influence a doctor to prescribe A versus B.
It may even be less straightforward and obvious a connection. I mean, I have asthma, and I’m not going to go to the doctor and say “gimme Breo” (or whatever it was I saw on TV). But it might make me more willing to try Breo if the doctor suggested it - since I was already “familiar” with it by seeing it on TV.
Or the advertisement for RLS medication (Requip, when it was first approved for RLS) certainly caused some people to go “aha, I recognize that!” and bring it up with the doctor - whereas beforehand, the patient thought he or she was just imagining these weird syptoms. So an RLSer goes to the doc, describes the symptoms; the doc has just heard of this “new” drug, and prescribes it. I specifically use RLS as an example because it is a condition that so many doctors are unfamiliar with, and/or have no idea of appropriate treatment.
Getting back to the subsidizing issue: I don’t know what the numbers all boil down to if you add in all the R&D costs and then look at what the companies can charge in non-US countries versus in the US. Certainly they’ll have less money if the US cracks down on prices - if you sell a thousand bottles at 10 dollars a bottle in Canada, and another hundred bottles at 100 dollars in the US, that’s 20,000 dollars total. If the US cracked down and brought it down to even 50 dollars a bottle, that’s a 5,000 dollar cut in income. But given how much is spent on marketing, if they couldn’t run TV ads maybe their outgo drops 4,000 dollars - almost totally offsetting it. Anyway - I suspect that there WOULD be a net cut in R&D budgets, though not nearly as dire as Big Pharma scaremongers would have you believe.