The latest from DTC Perspectives

A World Without DTC?

Critics constantly call for a ban on DTC. The most common claim is that DTC raises treatment cost because advertised branded drugs are often not better than generics, lifestyle changes, or other non-prescription remedies. They also say DTC creates imagined disease categories which cause people to demand expensive treatments for questionable conditions. They argue the DTC drugs overstate benefits without properly giving the risks. Critics bemoan the fact that the doctor-patient relationship is harmed by patient initiated discussions and demand for a drug. None of the above is borne out by the facts but the arguments continue to have traction in Congress.

Ok. Let's assume enough Congressmen agree and enact a ban that The Supreme Court says is constitutional. DTC is now banned. Is the health care system better off?

First, what will happen to cost in our $2.4 trillion annual system under a DTC ban? Let's assume the $5 billion annually spent on DTC leads to $10 billion in incremental drug sales based on many studies citing a 2 to 1 ROI. Ok we theoretically save four tenths of one percent of the annual health care bill. We cannot, however, assume that we really save all that money. Patients might spend that money on OTC's, alternative medicines, vitamins, special foods, etc. which may or may not solve their problem. Or not seeing the DTC ads they might just never see the doctor at all and eventually get sick, requiring more expensive hospitalization later. Some of the sales for DTC drugs are not covered by insurance so a lot of that incremental sales cost is borne directly by consumers anyway.

Second, what makes us think that drug selection will be objective and optimal if DTC was out of the picture? Drug companies still detail and promote. They run medical meetings, use opinion leaders funded by the drug maker, and provide samples. It is not always the best drug that wins. Branded higher priced drugs were a fact of life before DTC existed. Somehow DTC got the label of creating blockbuster drugs when in fact medical promotion creates most of the sales.

Third, payers such as insurance companies, managed care and employers will prefer to use drugs they get at a big discount. That may not be optimal for the patient. Without DTC that patient may never know an alternative exists to the favorite formulary drug. DTC puts consumer pressure on payers to offer or at least seriously consider the newest treatments.

Fourth, our government is not necessarily interested in the best treatment, only adequate treatment that fits a budget. Maybe a generic is acceptable to them but costs you, the patient a better quality treatment.

To recap, is it worth the theoretical savings of less than one half a percent to prohibit a free flow of information to consumers? Is it only drug information that will be restricted? A lot of special interests have a goal to hold back health information for a variety of reasons. We need to be careful assuming a ban on DTC would be worth the costs. Do we need to ban advertising on other luxury items because not everyone can afford them? One can argue that anything that has cheaper alternatives should not be advertised because consumers may be paying more than the item is worth. Sounds ridiculous, I know, but arguing that branded DTC products should not be allowed to advertise can be a slippery slope.

The best solution is to let information flow for DTC and other items with viable alternatives. There are plenty of sources of information on drugs, many of which are critical of branded drugs and offer alternatives. Government is free to publish clinical results that can refute claims of brands. Managed care can play one branded drug against another to get a great price. Doctors can decide if the branded drug really is better for their patients. Patients can check the Internet or ask friends if the drug works well. Putting the DTC information genie back in the bottle seems a bad alternative after 13 years of mass DTC availability.