I was reviewing some opinion pieces on The New York Times web site about DTC from 12/15/13. The section was titled Developing Cures or Hyping Up Demand. A number of industry critics gave their views, mostly negative. The usual reasons were given for the anti-DTC stance: DTC creates demand for drugs that are not needed. DTC raises prices. DTC overstates benefits. DTC makes Americans a drug dependent culture.
After 16 years of branded television ads and more than 20 years of mass media, DTC ads still generate strong reactions. These critics are right to have concerns. We, as Americans, are the ultimate society demanding instant gratification. We like quick solutions to our problems and needs. We borrow excessively to get what we want. We do not like to diet or exercise and would generally prefer a pill to solve our problems of gluttony and lack of exercise.
The question to be asked, however, is were we the same society before DTC? The answer is a resounding yes. Americans had the same bad habits in 1996 that we do today. Branded drugs were around pre-1997 and many were blockbusters.
In a perfect world, every doctor would be free to prescribe what they thought was best for the patient and every payer would fund that choice, regardless of cost. Every patient would have access to the treatments available and understand the benefits/risks of their options. In reality, information is not disseminated perfectly or objectively. We receive information imperfectly from many sources that have a dog in the hunt. No one source can be totally objective.
DTC is advertising that is designed to sell. It is, however, highly regulated advertising, and the claims made are true. The idea that ads can overplay benefits is not correct. Consumers may interpret ads and over estimate benefits, as they may also overplay the risks in the ads. DTC allows information to be disseminated and processed to consumers. The idea that banning such information will somehow help consumers is beyond me. In a world where doctors have an hour to sit down with patients and go through all the options, then DTC may not be needed. In the real world of 7 minute face time with the doctor that is not the case.
DTC is a conversation starter. That is it. It allows a drug company to introduce a product to a consumer. Of course a drug company wants to put its drug in a favorable light as do all advertisers of any product or service. Sometimes these critics imply Americans are just too dumb to understand that advertising is just that. Somehow they fear that Americans will be duped into thinking an advertised pill is a wonder drug. There is no evidence they do. Americans are a skeptical bunch and they do a lot of research on the Internet. They do not think every drug advertised will cure them.
I do believe some medicines are over-prescribed. We are a society anxious for a pill solution to our moods, our bad habits, and our inactive lifestyles. Perhaps we need more education on alternatives to pills. I would welcome insurance companies, physician groups, advocacy groups, and government running ads discussing alternatives to drugs.
One can argue that health information is special and cannot be left to the free market to disseminate and advertising is a bad way to do that. One could also argue that then we need to ban all medical advertising including the physician, dental, hospital, insurance, diagnostic, OTC, and supplement categories. I doubt this would be a good idea. What critics sometimes forget is that advertising leads to competition. Competition leads to the desire for product improvement. Advertising leads to price competition. These are all good things.
DTC advertising is not perfect. It does however lead to fierce competition and a desire to make better products. While sometimes it leads to “me-toos” or patent inspired manipulated minor changes, it also leads to new categories of drugs. We need to accept some messiness in advertising or alternatively we can stifle innovation and competitive forces. I am not naive to the fact that Europeans ban branded ads and their people still seem healthy. So there are legitimate arguments for not having DTC. It is a matter for continued policy debate. Let’s all keep an open mind to the pros and cons of healthcare ads.