These days, one cannot help but to notice on television and print media the tremendous amount of pharmaceutical advertising done directly to the consumer. Although certainly not the most expensive part of healthcare spending (indeed, only a few percentage points), this marketing costs the American consumer tens of billions of dollars per year reimbursing pharmaceutical companies for the expense of unfiltered advertising to the consumer. Again, although the actual dollar amount is small compared to the total picture, this advertising represents (in this author’s opinion) 1 of the most egregious conflicts of interest in the medical world. Let’s look at some of the background issues of this advertising.
The medication types advertised to the consumer are those almost always still under patent. That is, they represent a class of medication that is much more expensive than generics. Manufacturers want to recover the cost of developing the medication, test its efficacy via trials, and then petition the FDA for release. These costs are enormous and not every medication initially studied is effective or meets FDA mandates. In other words, not all medication candidates make it through this gauntlet.
A major feature of medications advertised directly to consumer is that they are almost always items requiring complex risk/benefit analysis to see if a patient is a good candidate for such treatment. Large families of medicines with unfamiliar category names such as -nib’s, -mab’s, GLP-1 receptor agonists, and others are being released by the pharmaceutical industry. They are useful to treat cancers, autoimmune diseases (e.g., rheumatoid arthritis and others), diabetes mellitus especially with elevated body mass indices, and possibly other conditions. Their methods of action are quite complicated. Even for those of us who have undergone studies at medical school, internship, residency, and even subsequent fellowship training (for subspecialists), these medications represent a challenge for selection, initiation, and management.
Thus, at the risk of excess levity about the issue, consumers should not be compelled by advertisements to ask their physicians if the particular monoclonal antibody seen on television with a catchy jingle and a well-choreographed dance number is appropriate for their care.
In fact, with the exception of the United States, there is only one other country in the world (out of a total of 195) which even allows direct to consumer advertising of pharmaceuticals. Interestingly enough, this is New Zealand. Everywhere else in the world (roughly 99%), this practice is illegal.
So, why above did I say that this is an egregious conflict of interest? There is no shortage of reasons.
Will the Board of Directors of the major pharmaceutical company authorize a balanced discussion of the pros and cons of using their product for a given condition? Absolutely not. They are bypassing the physicians in order to avoid such a balanced discussion.
Will that same board authorize a comprehensive explanation to the consumer of the significance of potentially severe and even lethal side effects? Again, absolutely not. At best, one can hope for a narrator in the background rapidly enumerating possible catastrophes with the medicines along the lines of “if you suffer asystole (cardiac arrest), contact your doctor within 8 seconds” while in the foreground there will be multiple dancers gyrating in visually joyful harmony.
Finally, will the board offer cases in which another product is superior for the patient’s needs? Well, the reader gets the picture.
The only good news is that the prescription still must come from a physician’s pen and that physician must attempt to choose the best course for the patient. However, pharmaceutical companies are not foolish and they know if the patient exerts enough pressure, the physician may yield in marginal cases and order these very expensive medicines. That is the sad truth.
So, at minimum, I hope the reader will view these advertisements with grave skepticism at minimum. Better still, we should contact our elected officials about disallowing this bizarre loophole of the law. It is not in the patient’s interest to allow this. These billions of dollars of advertising are passed through to the consumer later. Sadly, the headwind of pharmaceutical companies’ disproportionate influence with government is not trivial. We can do better.