Direct to consumer advertising works in correction facilities

One might assume that inmates in correctional facilities would not be influenced by big pharma’s direct-to-consumer advertising (DTCA) strategies. After all, their communication channels with the outside world have largely been silenced.

However, many do have access to television. And despite an increase in online pharmaceutical marketing, TV remains a common medium for trying to persuade patients to “ask your doctor” about drug X. Inmates also read magazines, another common advertising medium.

I’ve seen many inmates who have asked about prescription sleep medications (often costing close to $200 per month) that they saw advertised. “Why can’t I get some of that?” I’m often asked. I explain that it would be very unusual for correctional formularies to carry such medications. I explain that even my own health insurance plan, which is quite comprehensive, does not cover many of the newer sleep medications.

I’ve also frequently been asked about Abilify, a newer antipsychotic drug that has been marketed for use in combination with an antidepressant to treat depression. It’s not uncommon for a patient to have been on a starting dose of a generic antidepressant (pennies per pill in my correctional system) for a few weeks and then ask me about adding Abilify because they don’t think the antidepressant is working well enough.

If the antidepressant isn’t working sufficiently, then the next step would be to increase the dose of their current medication, not to add something else. When I explain that increasing their dose of is not only the next logical step but that adding Abilify, even at a low dose, will cost close to $500 per month and increase their risk of diabetes, high blood pressure, and other serious health problems, I usually get an “Oh, okay, let’s increase my antidepressant” response. They usually seem quite surprised when they learn just how expensive Abilify actually is.

But this necessary discussion also takes extra time–time which costs taxpayers money. Primary care providers also have to spend time addressing such DTCA issues in jails and prisons.

According to Wikipedia, New Zealand and the U.S. are the only two nations that permit DTCA. A U.S. Government Accountability Office report (pdf) in November 2006 revealed that in 2005, drug companies spent $4.2 billion on DTCA and $31.4 billion on research and development.

The report explains:

…studies we reviewed found that increases in DTC advertising have contributed to overall increases in spending on both the advertised drug itself and on on other drugs that treat the same conditions. For example, one study of 64 drugs found a median increase in sales of $2.20 for every $1 spent on DTC advertising. Consumer surveys suggest that DTC advertising increases utilization of drugs by prompting some consumers to request the advertised drugs from their physicians, who studies find are generally responsive to these requests. The surveys we reviewed found that between 2 and 7 percent of consumers who saw DTC advertising requested and ultimately received a prescription for the advertised drug.

So, DTCA clearly works. But is prescribing in correctional settings actually influenced by DTCA? I don’t know. Not surprisingly, I haven’t found any data about this topic. I suspect that it influences it some but not to the extent that it does in non-correctional settings (since correctional formularies are typically more restrictive than community formularies and because samples are not used in corrections). But if it influences prescribing to inmates at all, then it’s costing taxpayers extra money, money that’s not available in the current economic climate.

DTCA benefits nobody but the bottom lines of the drug companies. Contrary to what they want you to believe, it does not benefit patients. Patients deserve access to quality, unbiased health information. And with so much money at stake, the conflict of interest will always be too great for us to assume that their information is anything more than a sales pitch. But it’s been a very effective pitch, one that’s even managed to reach and influence those who are incarcerated.

Jeffrey Knuppel is a psychiatrist.

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