My Daughter Trulicity

I find it curious the creative nature at which new parents name their children these recent years (or even decades). Where do they come up with those names? Where can they find more? I have one thought:

 I came home the other night forgetting the slumber party my daughter had arranged for that evening. I walked in and was gleefully accosted by my daughter’s two best friends Cymbalta and Pamelor.  They were immediately joined by Lyrica, Latuda, and Humira all very anxious to introduce me to their new Latino friend Fetzima.  I went into the family room to meet her and first saw Eliqus (a bit mature for her age) lounging in front of the TV. Before I could say a word the doorbell rang. I went to answer it with my nervous looking daughter and there on the doorstep were three familiar boys Paxil, Lipitor, and Cialis, plus an Italian exchange student named Entresto. I said “not tonight fellas”, and asked my daughter, Trulicity, to close the door gently.

That’s right, in the endless quest to find names that distance themselves from such as Kathy, Susan, Jane, and Amy you need go no further than your flat screen TV. At almost any given time you will be subjected to long, drawn out prescription drug commercial that features a clever name that’s just perfect for your next born. Further, they’ll use the name repeatedly in the most comforting of situations; romantic fall colors, bubbling brooks, colorful kites, loving smiles, you name it. How could you go wrong? Besides, you’ve paid for this creativity…dearly.

In the 1980s, under the banner of deregulated free markets holding sway during the Reagan years, the FDA made no attempt to restrict pharmaceutical companies to advertise on television and radio. Today only one other nation in the world (New Zealand) allows such advertising. Since that time our Nation’s drug suppliers have spent hundreds of billions of dollars on “direct to consumer” (DTC) advertising of prescription drugs (Rx). 

There has been a bit of controversy to this practice surfacing from time to time, but mostly there has been a passive acceptance. The affect of advertising is normally positive in a free market, even necessary, but it is also potentially insidious. We view advertising submissively, rarely thinking about it.  Its very purpose is to create recall only at that the time of or decision to purchase.

The limited debate over DTC Rx advertising has mostly focused on the effect advertising has had on the decision making of the doctor: to what extent does the motivated patient sway the doctors decision making on which drug to use.  I believe that debate is useless and nearly irrelevant. It requires second guessing physicians and cannot be determined in any practical way even if we intuitively know it’s true.  The primary debate should be centered on the economics of DTC Rx advertising, what is really happening and what the obvious consequences are.

Advertising by definition is targeted toward a consumer who might be interested in purchasing the product advertised, or to the individual who might influence the purchaser (such as advertising to small children).  DTC Rx falls loosely into that second category.  The identity of the Rx consumer, however, is the first misnomer.

The patient is not the consumer when it comes to Rx, rather the purchaser is the physician. It is important to understand that the patient doesn’t buy Rx for himself, rather he/she buys it for the physician.  Prior to the development of retail drug distribution, doctors disseminated Rx when the patient was seen and the patient would pay or reimburse the doctor as part of the overall cost of treatment, just as it’s currently often done in hospitals.  As the number of Rx expanded it became impractical for doctors to maintain the drugs and so Drug Stores became a centralized point from which doctors could disperse medications. 

Therefore, DTC Rx advertising is directed toward individuals who can’t buy the product, any more than a three year old can buy that box of Cocoa Puffs she’s seen on TV.  The difference is, of course, the Rx purchaser is an adult who actually thinks they are the one buying the Rx. At least the 3 year old intuitively knows their Cocoa Puffs are coming from mommy. I believe it is this misunderstanding by adult patients which fundamentally impedes this debate from reaching the American people.  It is our profit driven health care system that suppresses the issue.

Cost of Healthcare and Prescription Drug Advertising:   The American health care consumer should constantly be reminded that the cost of health care for him/her is revenue for someone else.  There is a transfer of wealth in the US of over $4 trillion annually.  An estimated $30 billion of that amount goes to those involved with the marketing of Rx (advertisers, media, and the marketing overhead of the pharmaceutical companies).  It matters not what health care plan our current or prospective political leaders espouse, none will work unless the cost of healthcare in the US is reversed. The billions spent on DTC Rx advertising are perhaps the most wasteful dollars spent in our ongoing healthcare catastrophe as they do not directly benefit the healthcare recipient or the system generally. In fact, there is no benefit, direct or indirect, to the patient. The only purpose is to generate profits for the pharmaceutical companies.

Prescription Drug Advertising as a Disincentive for Drug Research: The argument frequently heard from drug companies is that the price of a drug is often very high due to the large investment that took place prior to the drug being released to the public. It is a good point as those costs must be recovered, as well as the costs of research on failed drugs that ultimately are not released.  However, once the drugs are released the revenues can be used for further research on new and improved Rx, but what happens?  The Pharmaceutical Companies continue to invest in these drugs, in the billions of dollars, through mass marketing. Not only are those billions not being used for further research, but they drive up the cost. Further, with the Pharmaceutical Companies continuing to invest billions in a drug to make it more profitable, there is a disincentive to develop a new and better drug that might replace the highly marketed drug. It is simple human nature (and therefore business nature) that they will continue to support these marketed drugs rather than new ones due to the continued investment from which they have calculated an expected financial return.  None of this equates to any benefit for the patient…past, present, or future.

Prescription Drug Advertising Adversely Impacting the Quality of Rx: As the Pharmaceutical Companies continue to invest in a prescription drug they become less likely to continue critical review of that drug, or maintain even a practical semblance of objectivity in any critical review. Again, why would they?  Not only have they invested in the development of the drug, but after its release they continue that investment and now have projected levels of profits to defend.  There is a further element, however:

With mass marketing the pharmaceutical companies have exposed themselves to more liability; both on a retail level which can affect shareholder equity, and on a tort level with possible injured parties.  This has already been made obvious by several highly public drug failures such as with Vioxx and several statin drugs. The heavily marketed drug increases public awareness, which is what mass marketing is supposed to do.  With that visibility, however, comes equally visible news worthiness should a drug fail. This becomes merely a cost of doing business and an indirect expense added to the retail cost of the drug.

There are other less critical reasons why Rx advertising should once again be banned from radio and television:

The information regarding the prescription drug that is supposed to be provided with the advertisements is laughable and completely ignored by the FCC.  It is the audible and visual equivalent of an 80 year old trying to read minuscule type on a label without glasses, she knows it’s there but it has no meaning. Warnings of death or diarrhea while people are dancing in flowered fields or hugging babies are pointless. In fact, it is a practical impossibility for such communication further strengthening the point that drugs are marketed to the wrong people.

We know the uninformed influence of the patient adversely affects the doctor’s best decision making, we only don’t know how much, and we never will. We also will never know to what extent mass DTC Rx advertising contributes to defensive medicine, although it surely does, putting both the patient at some additional risk and driving up cost.

Mass marketing of prescription drugs exists because, for the most part, it accomplishes what it seeks to do.  It gets the patient to influence the consumer (the doctor) to buy the Rx thus increasing sales and profit.  However, in a world where healthcare should be an available standard commodity to all people, like clean water, then prescription mass marketing takes us in the wrong direction.  It is far from an answer to the overall healthcare problem, but its elimination would take us one step further in the direction we need to go, and at $billions a year it would be no small step.

Think about it. How worse off would your life be if you never saw another prescription drug commercial again?  Call or write your Congressional representative.