Map of life expectancy at birth from Global Education Project.

Monday, January 22, 2007

Why would I try to mislead you just because I can make billions of dollars?

In what is generally an interesting business section in today's NYT, Milt Freudenheim does direct-to-consumer (DTC) drug advertising. Unfortunately, while the headline says that a "Showdown Looms in Congress" over the issue, there's precious little evidence of a meaningful showdown in the article. Apparently there will be hearings of some sort, but the only proposed legislation is coming from the pharmaceutical industry.

It may seem paradoxical, but the industry wants to establish user fees from its members to pay for FDA staff to review ads before they are aired (or cabled, or whatever verb describes modern TV technology). Why would they want to do this? I presume it's to head off any more meaningful restrictions or even a ban. DTC advertising is in fact banned outright in every civilized country except the U.S. and New Zealand.

The industry has learned that the law that finances the drug approval process with user fees was very much in its own favor -- he who pays the piper, etc. This system would prevent outright restrictions such as requiring companies to wait long enough after drug approval for safety and effectiveness to be well understood -- a matter of years if we were to be honest about it -- or requiring more extensive disclosure of risks. (Now they can just refer you to their ad in Cooking Light.) They say a ban is unconstitutional, but come on now. The First Amendment is talking about political speech, not travelling snake oil shows. Of course, the Supreme W.* Court hasn't been entirely clear about this.

The drug companies argue that DTC advertising is good because it informs people about products that may benefit them. All I can say is pish tosh. They don't advertise drugs to inform consumers, they advertise drugs to make money. Otherwise we'd see nothing but ads for hydrochlorothiazide, lisinopril, and atenolol. Instead, we see ads for expensive, patented name brand drugs that very few people ought to be taking, and that anybody who arguably should be taking, who has health insurance and is seeing a competent physician, already will be discussing with said physician. If they don't have health insurance, they can't afford them anyway.

And no, I don't want to see thiazide diuretics advertised on TV either. Doctors should be talking with their patients about that sort of thing and they should be making decisions without interference from the manufacturers who are trying to make money off of the deal. DTC ads exist for one purpose only, and that's obviously to try to get people to take drugs. That's the wrong objective. The right objective is to be well informed, to weigh risks, costs, and benefits, and do what makes sense for you in light of expert advice. You'll never get that from an advertisement.

Direct to consumer advertising of prescription drugs should be banned entirely. Period. And there would be an important side benefit: much less incentive to invest drug development money in drugs that are likely to be profitable if and only if accompanied by an expensive ad campaign. That's the only reason that so-called "evergreening" happens -- development of slight variations on drugs that are now in the public domain, that can be sold at high prices under marketing exclusivity but only if ad campaigns can persuade people to pay the extra cost. The money the companies now spend on advertising would also be fed back into real research, or lower overall prices. Total spending on health care would go down. Insurance would be cheaper. Medicare and Medicaid would save money. The creative geniuses in the drug advertising business would have to find honest work, if they can conceive of such a thing. Everybody's a winner.

*My finger still hovers over the "W" key every time I type NYT. We'll see how they cover the 2008 campaign. I recommend The Daily Howler for a daily dose of expose. (Somerby briefly lost my endorsement when he inexplicably started channeling Karl Rove on the subject of Ambassador Joseph Wilson, but he's now transcended that weird brain fart.) But the Supreme Court deserves W every time, when it comes to the invented rights of corporations.

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