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A week ago, my wife Debra broke her hip in a fall. The experience has given me a better appreciation of our health care system. While not perfect, I am impressed with the speed and quality of the care American style. That is, the for profit hospital was interested in her satisfaction as a customer. They were interested in making her happy, so they can be known as a customer centric facility. In today’s social media world customer ratings matter. They touted their ratings on billboards placed in their lobby from several sources such as Healthgrades and US News and World Report. They were aware that she may go to customer rating sites after her discharge and did whatever they could to ensure good feedback.

I frankly expected the typical poor hospital experience based on past interactions with emergency rooms and being admitted for surgery. The last time I was hospitalized was about 20 years ago. That experience was characterized by a diffident nursing staff, a cramped double room with a moaning roommate, and of course lousy food. Move ahead 20 years and everyone at this hospital was interested in ensuring a positive experience.

My underlying point in this is that those who advocate the federalization of healthcare may not like the result. I have had few positive experiences with government agencies. It is not that they are staffed by bad people, it is that they do not make customer service a priority. They do not have to. We have one choice for paying our taxes, getting our passport, getting through airports, and that is Uncle Sam. Sometimes he can be slow, unfriendly, rigid, and lacking in empathy.

In the case of my wife’s emergency surgery I had choices and could accept or reject the hospital and surgeon. Admittedly, once my immobile and in agony wife was brought in, we were kind of a captive audience. Still they knew she could request a move to another hospital and went the extra mile to ensure she stayed. My personal physician did not have privileges there so it was a serious consideration to move.

What I noticed most was the staff always asking if she was satisfied. This was from the ER nurses to the aides taking her meal orders. She felt like a valued customer rather than a burdensome patient. While she was anxious to get home she felt comfortable staying there. The lesson I learned was the enormous opportunities that still exist in healthcare to delight the patient. The hospital staff explained that all the rooms in the new wing were now singles because they knew patients valued their privacy. The visitors have free valet parking. Nice touches.

I know Bernie Sanders thinks government would do a better job running the healthcare system. Somehow I doubt single rooms and valet parking would be part of their plan. I also doubt customer satisfaction would be anywhere as a top priority. Yes, I am confident care would be adequate under a government run system. For my wife the stress of breaking her hip and going through emergency surgery was enough, and adequate care was not what we wanted. We wanted customer centric care and the for profit model provided it.

I thought about how much more we can do to unleash free market customer centric care. We can lower costs and improve care just by letting for profit companies compete. Profit and free choice are powerful motivators for innovation. We should encourage more of it rather than hope government is the solution. Just think the post office versus FedEx as the analogy. I know which I would choose.

The widely reported story that Amazon is considering entering the prescription drug market has made current drug sellers nervous. Could Amazon revolutionize drug sales? Or, would they just be another mail order supplier in a crowded market? The answer is unclear.

Amazon certainly has the strength to cut deals with drug companies, insurers and major employers to supply drugs. If a major insurance company wanted to work through Amazon to try to cut costs it is likely they could shave some expense. I do not, however, understand yet how Amazon would be able to fundamentally change drug delivery or pricing.

Drug companies have established a complex supply chain with numerous levels of prices across different customer categories. Drug companies have no problem quickly supplying patients through drug stores, mail order houses, or in store pharmacies at supermarkets/big box chains. While certainly a convenient place to shop its many product categories, are there advantages for customers buying their drugs there?

I have increasingly bought more things on Amazon because I get free delivery through Prime. Their service is reliable. It is nice to be able to buy directly from them or their listed sellers. That being said, Amazon is still just a giant online market. Patients already have a vast array of options filling their prescriptions and I never heard anyone complaining how hard it is to fill a prescription. Unless Amazon can significantly lower consumer price, or save insurers lots of money, then the game changing aspect of their market entry is unclear.

I love Amazon and was lucky enough to hold on to my 200 shares bought at $35 many years ago. As big a fan as I am of their company, to change how drugs are sold is not easy. Maybe all Amazon wants to do is be another online option and grab a share of the huge market. Certainly, they have an enormous customer base who would be happy to add drugs on with other purchases.

Of course, Amazon is an innovator and maybe they will be able to add consumer value to drug purchases. Perhaps they will be able to launch retention and compliance programs using their customer research base. Alternatively, they may be able to innovate in disease and drug education. Their major asset is consumer trust and that should never be underestimated. Amazon has a team evaluating entering the market and my guess is they will enter, even if just as an ordinary supplier at the start. Long term I suspect they are thinking of ways to shake up the supply chain to offer substantial discounts to their customers.

My question to the DTC community is why can’t we come together with FDA and make DTC advertising more understandable.

I am not talking just about risks but also benefits and indications. We are all letting the approved label dictate how we say what we say. That label information is generally not consumer friendly. Consumers see advertising, not as a whole sales pitch, but merely the start of a buying process. DTC, because of regulations, seems to be treated as requiring an entire pitch where virtually everything must be discussed. Look at cancer advertising for example on non small cell lung cancer. I’ll use Keytruda as an example which is required to say it is indicated if PD-L1 is positive and there are tumors with no abnormal EGFR or ALK gene. Huh? Merck has to say it but does any consumer know what any of that means? I doubt it.

What we have are technically oriented government regulatory bureaucrats in a non-technical DTC world. They should spend their time making sure everything said is true but also understandable. Instead of forcing Merck to discuss abstract qualifications on who might benefit, consumers would be better served knowing more about clinical results. Wouldn’t it be better to say Keytruda only benefits a segment of lung cancer patients and only your doctor can say if you might benefit? After all, patients do not self diagnose PD-L1 or their gene abnormalities.

FDA can make the 60 or 90 second ads much more consumer friendly and increase comprehension if they acted more like common sense regulators. They know many ads are data crammed and difficult to follow but it is their view that the label is like the Ten Commandments. Thou shall not deviate. So we get required language that is just wasting valuable air time that might be redirected towards giving consumers information they need and more importantly understand. I know Merck would probably like to do that. I also think OPDP would like it that way because I know the people there are trying to do right. Do we really think Congress intended consumer confusion in the 1970s when they wrote the regs never contemplating DTC?

Has OPDP pushed back on the Congressional committee regulating drug promotion that we need new promotional regulations? We can recognize that consumers just want mass media advertising to inform them that something might help them. They do not need the whole story rather just enough information to ask their doctor or search the Internet. Using the excuse that the regulations require all this complexity is abdicating the role FDA should have. We want drug DTC claim ads to be accurate and disclose serious risks. Surely, there is a better way. It will take FDA, Congress and drug makers to collaborate to determine how to improve. This is simple really and FDA should lead that effort.

Does anyone feel that we have done the proper job educating consumers when arcane medical terms are dominating DTC? Regulators tick off required boxes on their label checklist for DTC knowing full well consumers are often left clueless. My suggestion is OPDP have hearings on how to completely over haul DTC communication for today’s media environment, instead of using the excuse that they are captive to regulations written almost 50 years ago.