"Unbridled Promotion" a No-No

Sez Topol--no, not the second-rate Zero Mostel impersonator, nor the namesake of "the smoker's toothpaste." It's Dr. Eric J. Topol, a big wheel of cardiovascular medicine at the Cleveland Clinic, who's down on direct promotion of drugs to consumers. Looking upon the recent problems with Vioxx, Celebrex, etc., he despairs:

"Unbridled promotion exacerbated the public health problem…The combination of mass promotion of a medicine with an unknown and suspect safety profile cannot be tolerated in the future."

Whole story here.

A few points in response:

First, direct-to-consumer drug advertisements obviously increase awareness of a given product; that's the point. But that doesn't translate into a lemmingsesque population demanding their inalienable right of Celebrex or heartburn relief. It may (may) be precondition for consumer demand, but it's hardly sufficient.

Second, many, probably most, doctors don't keep up with anything and the information encoded in ads helps patients get around the gatekeeper function often served incompetently by out-of-touch general practitioners and the like. Indeed, the real problem may be with the prescription regime itself, which creates all sorts of weird issues in both the development of, promotion of, and information flow about drugs. If pot and cocaine should be legal (without a prescription), so should Vioxx and Celebrex.

Third, drug companies want to sell drugs and make huge profits (not that there's anything wrong with that, as Ronald Bailey pointed out a few years back). If they are making grandiose and misleading statements about the effectiveness and efficacy of their products--and the case against many prescription drugs such as say, Vioxx, is far from clear-cut--then choking off the information flow is hardly going to help. Really, is there any other product field in which having more people know less leads to better results?

As a summa cum laude graduate of the Quinn-Martin School of Hard Knocks, I know that corporate tycoons are evil and that their main goal is to sell shit that will in fact kill their customers. But I also know, as Milton Friedman once said in the pages of Reason, the genius of a market system is that, when free of interference (such as we see with the Food and Drug Administration, the prescription regime, current licensing practices, and more), it sets producers against one another to debunk themselves in a competitive marketplace. The process isn't perfect or error-free, but it's better than alternatives, including centralizing all approval and information in a single expert source.

Which is what Dr. Topol is talking about ultimately. Indeed, I find it hard not to read his--and similar--criticisms as an attempt to regain control over a medical system from which power has been moving from established authorities towards patients. There's no question that doctors--like lawyers, teachers, politicians, clergy, and other established authority figures--have taken it on the chin over the past several decades, increasingly bypassed or minimized by masses who feel empowered by general increases in wealth, education, and technology. Doctors are still rich and high status, but they increasingly resemble high-end car mechanics and other service sector types who must trade in "customer service." That is, their days as demi-gods in American society are coming to an end and they will certainly try to maintain their position for as long as possible. And will try to do so by arrogating for themselves the right to make decisions for patients/consumers.