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May 14, 2007

Kerry Howley asks whether doctors have a conflict of interest when they push pills on their patients.

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thoreau|5.14.07 @ 5:17PM|#

While I don't find a whole lot to praise in your typical pharma ad, even incomplete information for the consumer is still better than a marketing model that involves buying pizza for half the staff in the hospital. It's one thing to give the doctor free samples, or even those colorful posters with disease and drug info (however skewed that info might be, at least it's relevant to the product).

So if the marketing model is starting to shift toward consumer information, however incomplete it might be, that's at least better than what we had before.

|5.14.07 @ 5:20PM|#

Those who would ban the ads need to explain why too many prescriptions are worse than too few.

They won't have to, the public already takes that as a given. There's something in our national psyche that regards needing a medication as a shameful weakness, and an assumption that most people are "just faking it". Of course, I only have anecdotal evidence for this.

thoreau|5.14.07 @ 5:26PM|#

BTW, I'm well aware that the "pizza for all the staff" marketing model simply reflects a system of gatekeepers that stand between the patient and the seller of medication. My interpretation of the shift toward consumer advertising is that gatekeepers are becoming less significant in practice, while they obviously remain important on paper. (i.e. The rules still say you have to go to them, but they are becoming more accomodating.)

What's amazing about the pharma sales people is that I know a doctor who refuses to meet with them, but also knows better than to stand between his staff and a free meal. So his staff will not accept any paraphernalia with the drug company name on it, but they are allowed to accept food. This way he never sees the name of the company and hence can't be influenced, but the staff gets free lunch.

You'd think that no drug rep would bother to come to his office, yet they continue to do so. Apparently they have a quota of offices to visit, or something.

bill|5.14.07 @ 5:31PM|#

Gardasil works for boys too.

Cesar|5.14.07 @ 5:36PM|#

The award of "worst drug ad ever" has to go to the recent 2 1/2-minute long Celebrex ad, complete with a repetitive elevator music tune that will haunt you in your dreams.

http://www.celebrex.com/

Just when you think the ad is over, the narrator says "Lets dive *deeper*!"

|5.14.07 @ 5:45PM|#

As someone with a chronic illness that has spent the time to investigate all of the options and discuss them with my doctor, I am often fascinated how little most people with diseases actually know about their condition and what can be done. And doctors are often too busy to spend time educating the patient (I don't mean this as a slam against doctors, just as a point of fact). Anything that gets more information in the hands of the patient, even it is from a BIG, EVIL pharmaceutical company, is a good thing. If you really want to get into the nitty-gritty details of a drug, you can usually get all of that information at their website.

For example, here's the consumer Nexium site:

http://www.purplepill.com/

and here's the one for medical professionals:

http://www.nexium-us.com/

|5.14.07 @ 6:48PM|#

Why do people continually bury their heads in the sand and insist that medicine (and apparently those who practice and provide it) should be free of money? Direct-to-consumer advertising only increases patient visits to doctors and increases the chances that they may become informed on an issue. The bigger question here is what about medicine and its horrible non-market "reimbursement" scheme, causes doctors to abhor patient visits? Can anyone else think of a business model in which owners are concerned that there may be too many customers? If medicine were allowed to operate as a market all of these silly non-concerns would disappear, and patient treatment and satisfaction would improve to levels never seen before.

SIV|5.14.07 @ 7:33PM|#

Well, under the system we have now prescription drug ads should be banned.
Why adverise a product to the consumer they are not allowed to buy?
As consumers do not pay directly for medical services or drugs these ads lead to increased costs and unnecessary use of medical services.
Pharm ads treat adults as children encouraging them to beg and whine to the gatekeeper for their sugared cereal or Astelin.
Legalise the drugs and require patients to pay for them- then I would have no problem with pharm advertising

|5.14.07 @ 7:48PM|#

David,

Well, count me in on the medi-skeptics. Medicating a problem away should be the last resort. True, there are some conditions for which medication is the only or the best solution, but the negative effects of the widespread practice of throwing Ritalin and its successors at boys who are, well, acting like boys, should give pause to those who think that medication is always the best answer.

|5.14.07 @ 9:05PM|#

I work away from home and haven't bothered to get cable. Consequently I'm stuck with the local over-the-air CBS News on my little Wal Mart TV.

I've managed to handle the alarming news I hear/see with some equanimity, but the endless parade of commercials reminding me to watch out for cholesterol, asthma, sleeping disorders, enlarged organs,leaking organs, organs that don't enlarge (LD),cigarette smoke, disintegrating bones, mouth bugs, toe bugs, lung bugs,etc., was making me sick. Now I get my news from the web where ignoring commercials takes way less than 30 seconds each. And I feel much better.

Robert|5.14.07 @ 9:21PM|#

Telling is the industry name for prescription drugs: "ethical drugs". Implying that marketing to the patient is unethical.

|5.14.07 @ 9:24PM|#

David is incorrect: most Americans love medications. They see a doctor, demand a prescription, and expect immediate relief or cure. One of the main reasons antibiotics are overused is that when a patient has an illness that is almost certainly viral (such as a chest cold or acute bronchitis), he demands antibiotic treatment. Unfortunately, too many doctors give in because explaining takes too much (unreimbursed) time.

Direct-to-consumer ads for new drugs are typically factual but misleading. The ads do not tell you that there are 14 other drugs that can treat the problem, all of which are cheaper and most of which are safer. The ads do not tell you that there are ten contraindications, dozens of drug-drug interactions, and possible interferences with lab tests. I don't agree with banning the ads, but I think a big consumer education campaign is needed.

SIV|5.14.07 @ 9:42PM|#

Doc T
"overuse" of antibiotics?
any evidence taking a full series of common oral antibiotics to treat respiratory infections contributes significantly to resistance? I would think the chance of an underlying or opportunistic bacterial infection would warrant the use (prophylaxis).

Don't the "superbugs" largely originate in hospitals? (or third world brothels)

|5.14.07 @ 10:04PM|#

David is incorrect: most Americans love medications.

Your right, Dr,T, people do love their own medications. But when has that ever stopped them from judging everyone else?

|5.14.07 @ 10:10PM|#

any evidence taking a full series of common oral antibiotics to treat respiratory infections contributes significantly to resistance?

So, you don't believe in evolution / natural selection either? There are shitloads of bacteria in your intestinal tract, skin pores, and other places at all times. Taking antibiotics doesn't just target the area of the (viral) infection; it gives an evolutionary kick in the pants to all the bacteria that come in contact with your bodily fluids.

thoreau|5.14.07 @ 10:13PM|#

For the record, the guy posting as Dr,T is not me.

SIV|5.14.07 @ 10:26PM|#

crimethink,

that didn't answer my question

if your example is correct why does penicillin still work?

|5.14.07 @ 10:44PM|#

SIV,

It doesn't work anymore for many bacterial infections (S. aureus being the most infamous).

SIV|5.14.07 @ 11:03PM|#

Yet it works for most infections it was originally used for.

I am skeptical of much of the conventional wisdom on antibiotics. We load up food animals with antibiotics as prophylaxis (obviously a bad idea in regard to natural selection) yet Doctors put the blame on patients "overusing" and "misusing" the drugs. Patients aren't treating acne and earaches with vanomycin.

The serious superbugs originate in hospitals- not in patients taking amoxycillin to "treat" viral colds.

|5.14.07 @ 11:37PM|#

Regarding antibiotic resistance- I would agree that hospitals are the breeding ground for high level resistance. If one took amoxicillin then his Staph could become resistant. However, since amoxicillin was not designed for and will never be used to treat staph, such resistance is irrelevant. The misuse of antibiotics for viral illnesses (or even non-serious bacterial illnesses) has more harm for the individual patient's gut flora, and the results of potential yeast overgrowth, leaky gut syndrome, etc.

|5.14.07 @ 11:39PM|#

Regarding Vanc resistance--by its nature bacteria will become resistant to it if used alone. It is designed to stop growth rather than kill bacteria, so if used without a second agent, some bacteria can evade and become resistant more completely. Again--a hospital issue as outpatient Vanc is exceedingly rare.

bill|5.15.07 @ 12:12AM|#

Life was so much easier when people only lived to 30.

|5.15.07 @ 7:03AM|#

Am I the only one who finds it ironic that a group named Our Bodies Ourselves is pushing for less information for consumers? What ever happened to "My body, my choice"? Or is that only for some things?

Russ 2000|5.15.07 @ 10:48AM|#

Overuse of antibiotics is not patient driven, at least not via advertising as antibiotics are rarely advertised to consumers.

Direct-to-consumer advertising only increases patient visits to doctors

Thereby increasing demand for health care. Without an increase in the supply of doctors, prices go up.

I wonder what is limiting the supply of doctors?

Dave W.|5.15.07 @ 11:44AM|#

Thoughtful article on a difficult subject. Hope Bailey and Sullum read it.

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