The DTC Debate

Trent responds to my articles on DTC marketing yesterday. I’ve read and appreciated his prior articles detailing the economic impact of DTC marketing. He writes:

Anyway, the other point that needs to be made is this: even if you think that direct-to-consumer advertising of pharmaceuticals needs to be restricted, it is extremely disingenuous for physicians to make these claims. For they are direct beneficiaries of such restrictions . . . I do impugn the motives of physicians as a group who call for such restrictions. If it walks like rent-seeking, and quacks like rent-seeking . . .

My point is simple and not nearly as nuanced. If the majority of DTC marketing were based on sound evidence-based medical principles, I would be in strong favor of it. After all, the more information patients have at their disposal, the better.

However, this is simply not the case, as the evidence seems to always interfere with profits. All we see are countless ads for erectile dysfunction, Singulair for allergic rhinitis (a second-line medication), Nexium (which essentially is repackaged Prilosec OTC), and Celebrex (when an NSAID or Tylenol would suffice in the majority with osteoarthritis) to name a few. I won’t even get into Vioxx, which was relentlessly advertised before the realization of adverse cardiovascular data.

Do you ever hear Pfizer advertising Accupril for diabetic hypertensives? No, instead their marketing muscle is behind things like Caduet, which is not nearly as useful a medication, and simply exists because the patent to Norvasc is expiring.

A commenter to Trent’s piece writes:

I am sure that doctors, even as a group, truly believe that they are more qualified than patients to make decisions about which drugs are best, just like priests believe they are better qualified to interpret the Bible for their flock.

Even if it is true in a general sense that doctors are better equipped than most people to interpret medical information, it is not possible for a doctor to be an absolute expert in every drug and condition, whereas a patient has every incentive to learn as much as possible about a drug that they are thinking about using. Meanwhile, the doctor is getting most of his or her information on drugs from the PhysiciansÂ’ Desk Reference, which is put out by the drug companies.

That is true. As a physician, I hope that I am more qualified than patients to make decisions about medication (or else that 4 years of medical school and 3 years of residency would have been a waste). I’ll go out on a limb here, but I also believe that most patients would want their physician to be better qualified than them as well.

I also agree that it isn’t possible for a physician to be the absolute expert in every drug and condition. However, having patients rely on direct-to-consumer advertising for their education isn’t the way to go. As detailed above, pharmaceutical companies aren’t all that interested in what’s best for your health, just their bottom-line.