These ads are one of the main reasons I became a cord cutter. I'm very happy they have not yet followed me onto any of the streaming services I use.
They are the creepiest thing ever on television. The actors sit around dinner tables with family members speaking unnatural, FDA manipulated dialog ("Oh, I'm doing great, I've been taking Pradaxa for my afib, not caused by a heart valve problem!") Then you get the unending list of side effects read aloud ("death" almost always one) while the actors smile and stare off into space.
Occasionally, one of these ads will come in a 2 minute and 30 second variety that fills the entire commercial break.
A regulation I'd like to see is that all the side effects must be acted out in the commercial as they are read. Show the peacefully sleeping woman suddenly awakened, choking on her swelling tongue. Or a man running around with an actual 4+ hour erection.
The irony of wanting to ban Rx drug ads because they are creepy, is that it was regulations that made them creepy to begin with. (You seem aware of this already)
There is an argument to be made for consumer advertising for a drug like Viagra. Without awareness that an effective treatment exists, patients with ED or another embarrassing condition are not likely to bring it up with their doctor on their own, thus resulting in unnecessary suffering.
Another argument is that for various reasons some patients are unlikely to seek a second opinion, even when one is warranted. Consumer advertising is a way to present alternative treatment options to a patient whose doctor will not.
We don't have ads for this in Australia, and everyone knows about viagra. Ads for drugs aren't creepy, they're fucking crazy. When I watched hulu for a bit I was astonished by them fascinated. Terrified. The US is wild west capitalism
EDIT: And another thing: you guys don't even have affordable health care, so people see this shit they blatantly can't afford advertised at them relentlessly. That's why spam is so lucrative I guess: huge demand built for something virtually no-one can afford.
> they blatantly can't afford advertised at them relentlessly.
That's not true, because most people do have insurance. The major problem is that the costs are socialized by insurance, so people buy excessive healthcare because then can afford it (they aren't paying).
There are countries where few people have insurance. Health outcomes are poor.
There are other countries where everybody has insurance and the government negotiates medical prices. Japan, Germany, and France are three examples. They have much lower costs than the U.S. and the best health outcomes in the world, measured on criteria like death rates after diagnosis of major disease.
Something else those countries have (to varying extent) is strong public transportation and an ancient and coherent food culture, which has helped them resist the epidemic of obesity and diabetes we are suffering in the US. Does your book address this?
Dude if you think medicine is TOO affordable in the US then you are seriously out of touch with everything. eg. http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-s... the comparative cost of have asthma in the US even if you're insured, compared with having it in Australia or most of Europe or New Zealand is sky high. Antidepressants similarly - in Australia you can afford that shit if you're completely poor. Americans need crazy insurance that they get through work to cover it, and then they have to pay through the nose as well.
> Without awareness that an effective treatment exists, patients with ED or another embarrassing condition are not likely to bring it up with their doctor on their own, thus resulting in unnecessary suffering.
Research has found that 80% of over the counter and 60% of prescription drug ads are misleading or false.[1] ED mediations are one of the top offenders in false advertising in the study.
Wow! That seems like a biased study. Would they have prefered the ad say "will help make your penis erect when you are appropriately aroused"?
One of the repeat offenders, said Faerber, were erectile dysfunction drugs. “The various drug companies phrase it differently, but they all play on the idea of being “ready” when the moment is right,” but Faerber said readiness is about more than a physical reaction, it’s an emotional state – especially where sex is concerned. “They implied more than a physiological response.”
Honestly though, it's a good system. I can't actually tell you what brand that ad is for, but I do know that I can talk to my doctor about it if I have issues with PE!
Those ones are a huge scam incidentally. The drugs are old and relatively ineffective, but the advertising is to get people into clinics owned by the company which then funnel them to heart clinics for check ups before prescribing.
Then we have a tragedy of the commons, where Pfizer and Lilly (the makers of Viagra and Cialis respectively) will wait for the other to create generic ED ads that they will both benefit from.
Also, I imagine that the cost of making and running the commercial would be pretty trivial compared to the profits to be made from the sale of the product.
The solution seems to be public awareness ad campaigns to remove the stigma surrounding talking to your GP about embarrassing conditions, while still outlawing the advertising of specific drugs.
"Got Milk?" was originally commissioned by the California Milk Processor Board, which is administered by the California Department of Food and Agriculture (i.e. the government) [1]. Also note that milk lacks much in the way of strong brand identity or distinguishing features, unlike Viagra and Cialis which are very different medications.
That's a confusing argument - how would drugs for a condition come to exist without the existence of a patient population?
Your point is well-taken for individuals who don't fall in epidemiological categories (a 20-something is less likely to be asked about sexual dysfunction than a 60 year-old). Still, questions about sexual function are standard medical history questions.
Education about the availability of drugs can be performed by disease foundations - indeed, disease foundations underwrite the most risky part of drug discovery, the basic research component. For more common disorders, hospitals, the CDC, the NIH and even Google are beginning to provide digestible information that highlight standard treatments. In our web era, the importance of TV advertising for disease education is likely less than it might have been in the 80s.
INT. BEDROOM - NIGHT
FADE IN ON: Supremely apathetic insomnia-afflicted MAN fantasizing
about putting a revolver to his head.
NARRATOR (V.O.)
(speaking at breakneck pace)
Side effects may include suicidal thoughts...
CUT TO BLACK as gunshot is heard. MOONLIGHT SONATA begins to play.
SUPER: Prozac - Because you deserve to be happy.
My only critique of your script is that the ordering between the side effects and the product name would seem to imply that other medications cause more side effects than Prozac
As Chris Rock put it some years back, the commercials are getting more and more ridiculous each year. To quote:
"So I was listening to this one where it goes... Do you go to bed in the evening and wake up in the morning? And I went Oh my god! I totally got that! I should go see a doctor!"
Wow, that was intense.. Not sure if I'd call it hilarious, but damn, that was mind blowing. (Also, check out the related video about smart pipe, it's depressing how close to reality that is.)
>These ads are one of the main reasons I became a cord cutter.
These ads are also an important source of revenue for the networks. The TV stations are going to fight this as much as the drug companies will, if not more.
As you point to, some of these ads are long and long means expensive. I don't see how the networks won't fight this.
If it becomes illegal to advertise drugs to consumers, the interesting thing won't be what the drug companies does (they'll just target the doctors and save a ton of money). The interesting thing will be what TV will do to make up for lost revenue.
> I'm very happy they have not yet followed me onto any of the streaming services I use.
Really? They're all over YouTube and Hulu. They even come in a special widget with tiny text automatically scrolling on the right half and the ad playing in the left half. Just as uninformative and prosaic as the over-the-air spots.
similarly, there should be a law that prevents the legalese fonts from being microscopic - there should be some minimum font size for these, regardless of where they appear (tv, print, online whatever)
> Then you get the unending list of side effects read aloud ("death" almost always one)
I think most of those rare side effects are not related to the drug at all. They just "happened" during the trials and they have to be included. At least in EU they are categorized by th frequency, so if the death is listed as 1 in 10000, I wouldn't consider it a side effect.
I understand that they are rare side effects and the disclosure is required by regulation. But it's creepy. Commercials for candy don't have to warn you that you can choke on it. Even peanut butter commercials don't have to mention peanut allergies.
I've never understood the logic behind prescription drug ads. The first rule of sales is to pitch the decision maker. You can't buy prescription drugs without a doctor's authorization, so basically the ads are asking people to go beg their doctors for medicine they may, or may not, need. The doctor, in turn, may give in to the patient's emotional pleas, since they are, in effect, in a customer service business. This would be an ethical violation. This rule would remove the ethical temptation of doctors
Further, it will be nice not to hear about an erection lasting over 4 hours, and not being too old for sex, in front of my 11 year old daughter while watching the news after dinner.
From a policy perspective, since the patients are not usually paying for the meds (you and I do), it makes sense to keep demand and prices low, as the doctors assert.
As for the free market, we do not have a free market in medicine. It is highly regulated through insurance and government regulation. So, I don't see a problem there.
"I've never understood the logic behind prescription drug ads. The first rule of sales is to pitch the decision maker."
Plenty of logic is there.
Part of the purpose is to make the Doctor pay attention to the advertising that they see in a journal. [1]
How?
Patient goes in and "asks their doctor" about a drug.
Then another patient. And another.
So now when the doctor sees an ad (or the detail man comes in) the doctor pays more attention and perks up. Similar I guess to the way once you buy a particular car model (or a friend buys one) you start to notice them all over the place. Same reason Pepsi puts ads in football stadiums. Builds general awareness and adds to reinforcement of the product as being "current".
HN works in a similar way for YC by the way. Repetition and current relevance very important in advertising.
[1] Edit: And of course Physicians also watch TV and read mainstream magazines and an ad is likely to stand out and get noticed just for that. (As a tech person imagine if you saw an ad for some software or SAAS that wasn't mainstream on the nightly news. It would certainly get your attention and stand out (more than if you saw it on Techmeme)).
Patient goes in and "asks their doctor" about a drug.
I wonder if this really ever happens. I mean, for many of the ads, it's hard to tell even what the drug does, so going to your doctor and asking for that med would amount to a random question.
Oh hell yes. The main one peaople ask me about right now is Marcumar/Warfarin, a drug many patients with atrial fibrillation have to take for the entire rest of their life, despite the fact that it has awful side effects and requires them to go to their doctor every two to four week to have a blood test done. Many patients are quite excited to hear that there's now new alternative drugs (NOAKs) that let you skip the biweekly blood draw. I get asked about Pradaxa, Eliquis and Xarelto so often, my standard Marcumar pitch now includes a whole paragraph about how those alternatives are just as bad. This is getting harder to sell as new studies are coming in and my arguments against the new drugs are steadily being reduced to "They're a lot more expensive." Patients really do NOT want to hear about how they have to get stuck with needles every two weeks so their doctor can save a few Euro a month in the prescription budget.
The whole NOAK advertising scheme seems like a huge win for the pharma companies to me. (Possibly also for the patients. Not so much for the affordability of our medical system.)
As an ICU physician, I hate the NOAKs. The data may say that they bleed less. However, when they do bleed, I've got nothing that really reverses the bleeding.
Of course, novel reversal agents are coming and each one will likely only reverse one drug... and each one will cost an arm and a leg.
I understand why patients do it. I just don't like bleeding that I often can't directly control.
Slight OT: How much more expensive does the stuff have to be that biweekly doctor visits for blood tests are cheaper?
(Not even getting into the topics of "how much is not having to do that every 2 weeks worth" and "can't the patient pay the difference if they want to?")
Judging from their comments; that doctor lives in Germany, which seems to have a national health care system (in addition to private insurance).
(In the US, a 15-minute doctor's visit could easily cost an end-patient $150-$200 out of pocket if their insurance doesn't cover it or has a high deductible; doing a blood draw every two weeks can get very expensive at that rate.)
Several of the the thinner drugs cost $10-20 a pill or in the range of $5000 a year. Assume anything you see on TV is a mi imum of $300 a month, perhaps more. The roll-on testonerone is $500 a month. Bushes generous medicare drug bebefit maxes out at 90%. It can still break you with a couple big ones.
>Patients really do NOT want to hear about how they have to get stuck with needles every two weeks so their doctor can save a few Euro a month in the prescription budget.
Most of these are for chronic conditions, where people are seeing their doctor on a fairly regular (once every few months) basis. And yeah, at least some patients absolutely do ask, "hey, I heard about X, is that good for me?"
There are of course also the extreme cases of specifically asking for a given prescription, but like the parent mentioned, just having a few patients persistently ask the doc about X is enough of a motivator to get the doctor to pay [marginally] more attention to the doctor-facing literature/ads/sales force.
Well let's say you have a discussion with your doctor and they note there is a drug for your gastroparesis.
They might mention some names or might not.
You aren't ready so you basically don't ask for a script.
Later a week a month whatever there is an ad for Reglan on TV and you think "hey that was what the Doctor mentioned".
The ad is an ad, well done, so you in theory are now more receptive to taking the med. Especially since your symptoms haven't gotten any better. You are more willing to consider a solution to your problem.
So next appointment you ask more questions and walk away with the prescription.
In Denmark you are not allowed to advertise prescription drugs, so they will just advertise the illness and symptoms and end with a "ask your doctor about this illness".
> I've never understood the logic behind prescription drug ads. The first rule of sales is to pitch the decision maker.
"Surveys conducted by FDA and private organizations consistently show that DTC advertisements have an impact on whether consumers request and receive a specific brand-name prescription from their physician. [...] In several of these surveys, consumers were asked whether they had seen an advertisement for a prescription drug and whether seeing the advertisement resulted in discussing the medication with their doctor and receiving the prescription. Most consumers (65 to 85 percent) remembered seeing a DTC advertisement. A subset of consumers who saw an advertisement discussed the medication with their doctor. The percentage of patients asking their physicians about a prescription for a specific drug was consistent across studies, about 30 to 35 percent of those who remembered seeing a DTC advertisement. One study estimated that the 32 percent of consumers in a 2001 survey who had discussed a DTC advertisement with their doctor translated into approximately 61.1 million consumers asking about specific medications. In the consumer surveys we examined, the percentage of consumers who, in response to a DTC advertisement, requested and received a prescription from their physician for a drug they were not currently taking was generally about 5 percent (ranging from 2 percent to 10 percent). By our estimate, this means that about 8.5 million consumers received a prescription after viewing a DTC advertisement and asking their physician for the drug in 2000."
> The data doesn't care whether or not you see the logic behind it.
This is true only if corporate executives are amoral automatons running hill-climbing algorithms. Rather than, say, citizens who use logic to make responsible decisions not just for their short-term profits but for the long-term good of their community.
This is true only if corporate executives are amoral automatons running hill-climbing algorithms. Rather than, say, citizens who use logic to make responsible decisions not just for their short-term profits but for the long-term good of their community.
Well, the system we have now really encourages that short-term, profit-finding behavior for corporations and the people who make decisions in them.
Many of the side-effects are just not part of the accounting, and therefore are not important to investors.
> Rather than, say, citizens who use logic to make responsible decisions not just for their short-term profits but for the long-term good of their community.
You say this as if there's no relevant data available. But again, if you can Google the actual answer, your 'opinion' doesn't matter.
In the US, the consumer drives a lot of the healthcare decisions.
This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing.
Additionally, this is a great backdoor way for consumers to be "educated" about conditions they didn't know they had. Consumers then would go to their doctor to talk about these things.
These advertisements are extremely effective at getting patients going to doctors about conditions they hadn't necessarily discussed with the doctor before.
> This has positives, as consumers can be more active participants in their health, but can also lead to people shopping for doctors who will prescribe the drugs that they want based on flimsy research and marketing.
Turns out, people suck at being intelligent healthcare consumers. Its not their fault though.
Most healthcare consumers don't shop around by cost for their healthcare, either because they can't (emergency services) or because its too damn hard (example below).
I encourage you to call your three closest hospitals, pick three surgical procedures, and ask them what the cash rate is from their chargemaster. You may get an answer from one hospital, possibly.
True! But the healthcare market is grossly inefficient. Prices are hidden from users. Drug makers can pitch straight to consumers, who aren't medical professionals.
I'd agree that consumers would shop around given the proper incentives, and as long as those incentives didn't diminish the healthcare they receive (or their health in general).
Single payer seems to be the better option. It streamlines collecting revenue for the program, and the program is large enough that it can bargain or set pricing with healthcare providers.
You could easily argue that "Most healthcare consumers don't shop around by cost for their healthcare because they don't pay the bills" is a good argument against single payer.
Honestly, I think if we treated medical insurance more like we treated car insurance, home insurance, et al, then the cost of medical goods would go down.
You seem fixated on price. "Active consumer" (the words in the post you were replying to) means more to me than finding the best deal. It means allowing the consumer to ultimately decide what is best for them, where price is one of several factors.
As far as the specific price question, with respect to drugs I can easily get that information from my pharmacist, whether it is the cost difference between a name brand and generic or just the prospective cost of a medication.
Have you ever lived in a country with single-payer healthcare? Let me tell you it's not all roses.
- Months long waits for anything requiring a specialist unless you're literally about to die.
- Arbitrary exclusions like dental and optical.
- Doctors taking in ~50% of the entire provincial budget and whining that it's not enough.
And at a typical tech worker salary this all this ends up being more expensive in additional taxes than just buying the insurance outright would be in the US.
If you're not poor, there's really no reason to prefer single payer.
Many (most?) private employer based healthcare plans in the US don't provide dental/optical. Those are each separate plans and premiums that you and/or your employer must pay for.
Your point about doctors taking ~50% of the provincial budget seems exaggerated (please provide a reference to support it). Even if healthcare takes 50% of the budget, it's not all going to doctors, probably not even the majority of that. There are a lot of expenses other than doctors in a health system (nurses, administrators, buildings, equipment, materials, etc, etc, etc).
And I can think of at least one good reason to prefer single-payer if you are a not-poor tech worker: Job flexibility. Since insurance comes from the govt instead of the employer, employees don't jeopardize or destabilize their health coverage by switching employers or switching to being self employed.
That 42% is the Healthcare Sector's share in the entire provincial budget.
It absolutely does not support your claim that doctors take in 50% (or even 42%) as it has already been pointed out that there are far more expenses in healthcare than simply doctors (e.g. drugs).
> If you're not poor, there's really no reason to prefer single payer.
There's the whole "I am not poor but I have compassion for those who are and don't want them to die and suffer for lack of medical care" angle that you might want to consider.
The first rule of sales is to pitch the decision maker.
You may need a prescription from a doctor to get a drug, but that doesn't mean you aren't the decision maker.
After finally getting a proper diagnosis for my condition, doctors began asking me "What typically works for you?" or "What drug do you like/is your preference?" I had a long history of health problems, thus lots of experience with what worked for me. After they gave me a proper diagnosis (and thus quit acting like dismissive assholes), I could walk into a doctor's office and say "I am having Yadda problem. I want (this list of meds) and am open to suggestions as to what else you think might help me." And get it.
Ultimately, I was the decision maker. The doctor's job was, in part, to inform me what my options were. But no one just crammed their medical opinion down my throat, even before I had a proper diagnosis and doctors were routinely being jerks to me and acting like I was some kind of hypochondriac.
It would be hilarious if commercial platform vendors had ads targeted to software development clients: "Ask your developer about .NET technologies for your next project".
I don’t think you are! :) I’ve seen these too, and I think they are a little funny, and fairly true. A dev will know Twilio is just how you do phone and SMS, and non-devs generally don’t!
The unfortunate truth is that a huge number of doctors are downright incompetent, and the healthcare system only allows you to see a limited selection of doctors. So until the system fixes itself, the onus is still on the patient to try to treat themselves.
Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay.
This is a good thing in one way. People should be free to buy chemicals at will. The disturbing part is that it's a forced tax paid to doctors to get RX's written each month.
Even worse, this further kills equality. A worker desiring to boost performance can easily afford top-notch medicines -- speed's only $20 a month for a starting dose at a pharmacy. But the prescription alone can be 10x that, and sometimes may be required every month. Not to mention the cost of a higher-end doctor that will assist customers. Poorer patients are thus denied medicine, creating a negative feedback loop.
this would introduce a myriad of acute public health issues and do great harm to the public good, costing taxpayers billions of dollars for remediation.
Are you not aware that 88,000 people die from alcohol-related causes every year in the US and that alcohol is the third leading preventable cause of death?
No, but I also don't think people should be free to buy any chemical at will. Alcohol is heavily regulated and still causes massive issues for society.
Alcohol is mostly regulated for taxation, not usage. (To the point of poisoning untaxed alcohol to make sure you get hurt if you sneak around the tax.)
it is most certainly regulated for usage. Widespread restrictions exist on consumption (usage) of alcohol in public places as well as within motor vehicles. It is illegal to purchase alcohol in the US if you are under 21 years of age, as it is to purchase alcohol on behalf of someone under 21 years of age; drinking is outright illegal for people under 21. Many counties around the country are "dry" counties where selling alcohol itself is entirely illegal. Regulations exist on bars as to when they can sell alcohol and when they can't, under what circumstances. Restaurants need special licenses in order to sell alcohol. All of these regulations are again in the interest of public health and the public good.
To claim that alcohol isn't regulated on usage or that most alcohol regulations are for taxation purposes only is pretty far off the mark.
The primary rationale for the taxation of alcohol itself is to counterbalance the public health issues that alcohol causes. Public health issues cost money to remediate.
Taxation is one reason. But we also regulate it so that only 21-and-over can buy it, that it can only be consumed in certain locations, and we also make illegal many activities that are performed while intoxicated.
I don't claim this myself, but I believe his or her argument is that the freedom to choose should take precedence over the cost to taxpayers, regardless of the cost.
I have no direct experience seeking a prescription, but I do know a doctor who has repeatedly complained to me about patients coming to him with the expectation of receiving a particular drug. He's considered giving up his DEA license to reduce this problem.
I was taken in an ambulance to the hospital once for a dislocated limb. I never understood why the paramedics seemed to find new satisfaction in life when I rejected the narcotic painkiller. Must have come as a pleasant surprise.
I was hospitalized for a bit a few years back. Several nurses commented passionately on what a relief it was to take care of someone who actually needed help, instead of the many people they have who come in complaining of pain just so they can get their morphine fix.
How do you respond to such a thing? If a patient is allergic to aspirin, concerned about liver toxicity from APAP, doesn't want stomach issues from NSAIDs, etc.? Do they just have to suffer or do you "give in" and provide them desired relief?
There's certainly a cynicism present in some providers - we're definitely not a perfect bunch, and some areas will have more explicit policy on the use of narcotic pain relief.
For me: I look at physiological symptoms. You tell me you're in 10/10 pain (the "worst of your life"/"worst you could imagine") and you're in no visible distress with normal vital signs, then I'll factor that into the decision.
That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body.
There used to be (probably still is) doctors in the ED who don't want a patient to come in with pain meds onboard because they want to see a "baseline presentation". Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane.
Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it's not "drug seeking" but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to 'give me the damn drug!").
"Do they just have to suffer or do you "give in" and provide them desired relief?"
No. There are plenty of other options for treating their pain without using opioids -- first I would educate them about the relative risks and benefits of, say, acetaminophen/APAP. I could use something like intravenous lidocaine or low-dose ketamine, or if it's a traumatic type of pain some kind of regional anesthesia. If it's more neuropathic, you can use tricyclics or drugs that work on GABA pathways. Beyond all that, I try to talk to people about the harms associated with opiates/oids such as hyperalgesia that develops in many long-term users, which is a really significant and underappreciated harm alongside things like addiction and potential respiratory depression.
Then maybe you should hold off on statements like "Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay." until you have direct personal experience with this.
Good? They're at least getting informed consent and an opportunity to be diverted towards harm reduction. Ideally if a patient stubbornly demanded a particular drug they'd be warned in graphic detail of why that was a bad idea, asked to sign a "Prescription AMA" form, and that'd be the end of it. If nothing else it would keep them in the system and out of the grasp of hucksters and literal druglords.
The guys in the park selling opiates at unspecified dosage and purity are available 24/7 and don't even ask questions.
> The first rule of sales is to pitch the decision maker. You can't buy prescription drugs without a doctor's authorization, so basically the ads are asking people to go beg their doctors for medicine they may, or may not, need. The doctor, in turn, may give in to the patient's emotional pleas, since they are, in effect, in a customer service business. This would be an ethical violation.
I think most of these ads are targeted to people who are already taking a drug for a condition. They want people to ask their doctor to switch to their drug - something a doctor would have far less ethical issues with.
The problem of course is people switch away from a drug that has worked for 40 years to something new because of advertising and their insurance (and in turn, all of us) ends up picking up the cost for something that may have no benefit whatsoever to the patient.
Others are so brutally generic that they could apply to almost anyone: "Do you feel tired regularly? Have trouble getting going? Talk to your doctor about xxx".
Whilst I realize a lot of this is coded talk for "Do you suffer depression?" for people who might not have realized or be willing to acknowledge it as such, the sheer number of conditions for which "lethargy" is a symptom...
Not everyone thinks that the health problem they're having is treatable - an ad can let someone know that there is a drug for condition X, prompting a trip to the doctor that would otherwise not happen.
One aspect that I haven't seen mentioned here is that these ads are also designed to improve patient adherence. So you have 30 million prescriptions of zoloft prescribed in the US every year (crazy right?) but there's a lot of money left on the table when folks don't refill. The ads are reminders to these people to go get that refill and get back on their meds. For people with asthma, diabetes and hypertension, non-adherence can be really unhealthy and leads to hundreds of billions in unnecessary cost to the healthcare system.
You can't buy prescription drugs without a doctor's authorization, so basically the ads are asking people to go beg their doctors for medicine they may, or may not, need.
FWIW, I asked my GP about this when I went in for a physical recently. He said he really doesn't get patients coming in asking for specific drugs in response to TV ads, and said he doesn't think it is an issue. Of course that's just one anecdote, but it shows that doctors are hardly in unanimous agreement on this.
I do think advertisements make a difference. For example for a given health condition if the advertisement says X is cutting edge, then automatically the patient who receives something else from this doctor would think he is not receiving the best medication possible.
This also explains why VISA and MasterCard advertise so much when you as a consumer simply take whatever the bank offers you.
It's the same principle at work when advertisers educate young children about how to nag more effectively.
Patients will go to their doctor and ask about a specific medicine and too many doctors will give in to this pressure if they feel that the medicine will not outright harm the patient. Patient happy, doctor can move on to someone who deserves his/her care more.
> As for the free market, we do not have a free market in medicine. It is highly regulated through insurance and government regulation. So, I don't see a problem there.
Plenty of us do.
The absence of a "free market" in this situation isn't merely a difference of driving economic theory, but of bodily sovereignty.
> The first rule of sales is to pitch the decision maker.
Or to pitch the influencers --- for example, grocery stores' putting sugary cereals on lower shelves, where kiddies can see them and ask mom and dad to buy them.
We have these ads for the same reason that bright sugary breakfast cereal is placed on the lower shelves in the grocery store. Children pester their parents for the cereal, and people pester their doctors for Viagra. But the children/people have to know about the product before the pestering can happen.
Clearly there are some ethical challenges. My doctors office is littered with Crestor clocks, clipboards, pads, exam table stirrup covers and medical models.
You can't say that seeing that logo 500 times a day doesn't influence picking Crestor over, say generic Lipitor.
You can't buy prescription drugs without a doctor's authorization, so basically the ads are asking people to go beg their doctors for medicine they may, or may not, need.
Same logic as for advertisements for children's toys, games and movies.
Its the same logic as with toy commercials aimed at children. Children influence their parents by nagging, and patients influence their doctors by nagging. Parents don't want unhappy kids, and doctors don't want unhappy patients.
> The first rule of sales is to pitch the decision maker.
McDonalds advertise at children so they'll harrass their parents into buying crappy food. Drug companies advertise to encourage people to harrass their doctors for prescriptions.
Found your problem right here. The news no longer serves to inform. It's little more than a conduit for fear, terror, and doubt. Switch off the TV and go read some websites or books to find out what's happening in the world other than the latest development in a terrifying incident in which a handful of people out of nine billion died.
Better yet, take your daughter down to city hall or a county government meeting, and get involved with what is actually going to affect you tomorrow.
Flip side is that it's vile that we need a "doctor's authorization" to even buy chemicals. While there certainly should be regulation to curb abusive advertising (e.g. fraud), it's sad anyone would find it wrong to ask a doctor for drugs. The way things are set up, that's exactly what many people are forced to do.
Also, nitpick, but the news and ads in general are almost certainly far more harmful (for your daughter; perhaps you, too) than hearing about ED meds.
Sure, things that are cause for large scale disease/biohazard might be a good exceptions. The medicines patients seem to be seeking most (psychedelics, relaxants, stimulants, painkillers, erection-assistants) don't seem to fall into this category.
The information provided to both doctors and patients by drug companies is marketing material. The best source of information is peer-reviewed publications, and even those are subject to some bias. Still, that's the best source we have, and should be the primary way all of us get health care information. If you, as a patient, do not understand what the reasearch articles are about, bring them with you to your appointment.
In my clinic, I do not accept visits or items from drug reps (including glossy marketing materials, pens, etc); the only thing they can leave me is a copy of a peer-reviewed article.
> In my clinic, I do not accept visits or items from drug reps (including glossy marketing materials, pens, etc); the only thing they can leave me is a copy of a peer-reviewed article.
> In my clinic, I do not accept visits or items from drug reps (including glossy marketing materials, pens, etc); the only thing they can leave me is a copy of a peer-reviewed article.
That's absolutely super good and I wished that more (all?) doctors followed your example.
> If you, as a patient, do not understand what the research articles are about, bring them with you to your appointment.
As a doctor do you actually take time for questions? Can you be my doctor? Most of the time the doctors I visit are quick to write a 'scrip to treat symptoms instead of taking the time to find the root cause. After 10 years still no luck.
However ... when I was unemployed, I was very happy that my doctor had free samples from her rep of $DRUG_THAT_KEEPS_ME_ALIVE. Our pediatrician also had free samples for some of the things our kid needed.
> However ... when I was unemployed, I was very happy that my doctor had free samples from her rep of $DRUG_THAT_KEEPS_ME_ALIVE. Our pediatrician also had free samples for some of the things our kid needed.
Just remember, public health care is communist! Better dead than red.
I wonder how long it's going to take to get our heads out of our asses, calm the fuck down, and really exploit civilization's gifts to take care of ourselves and our brothers.
The best way to tell which car is safer is to read the original cash-test reports. Furthermore, if you make a mistake in choosing your car, there is some chance you'll die as a result. Should we ban car commercial? Even car commercials that merely report (as they usually do) summaries of the crash-test reports ("best is class safety!", "4 stars from the car insurance safety board!"), because they may be biased in how they do so?
Cars are already heavily regulated. The minimum-legal car may not be comfortable and may not be pretty, but it'll be pretty darned safe and be decently efficient (considering the amount of material it is hauling around to be that safe). You can't advertise a death trap because it's already illegal to sell one. It's a poor comparison to the medical world where you can not help but do dangerous things to solve even more dangerous problems.
You are vastly more likely to die in a car crash than from a non-abused prescription drug. Furthermore, small cars are significantly more deadly than large ones and trucks. Car companies obscure this by comparing cars to ones "in their class", thereby misleading the consumer into thinking that their high-scoring small car is about as safe as it gets.
(I am putting aside opiate abuse, since illegal use is a different thing and opiates aren't advertised anyway. But this wouldn't much hurt my argument, since the deaths from cars are very comparable to opiate abuse, so one still can't argue that drugs are more dangerous than cars.)
Trucks? Last I researched this the Ford F150 and Dodge Ram -- popular, mainstream pickup trucks -- were by a large margin statistically among the least safe vehicles allowed on roads in America, compared across everything, not just in-class.
Doesn't really matter to my argument, but for fun: In general, heavier vehicles are vastly safer. If you raise the center-of-gravity off the ground a lot, and don't increase the weight much, it's probably possible to increase the roll-over risk enough to make you worse off.
But if you look at the data, you see that the deadliest vehicles are mostly compacts, and the safest ones are mostly SUVs.
Apparently I'm out of date -- SUVs and Pickups stopped dominating the death rates in the mid-2000s.
Still, the fourfold decrease in fatality rates across the ten model-years the IIHS publishes (coinciding with a substantial increase in the share of vehicle-years for 'mini' sized vehicles) completely discredits the "balance of mass" theory of car fatalities.
The stats that article links say that the 2011 mini cooper has driver fatality numbers that would have made it among the safest cars on the road in 2002. Eyeball regression says newer and pricier can explain essentially all of the safety differences, and vehicle size is at best a distant third.
The numbers in that article (fatalities per vehicle model over a year) aren't terribly useful - fatalities per vehicle mile would have more value.
In the end, though, there's little doubt that the U.S. roads are the host of a vehicle size arms race - build in as many safety features as you like, a sub-compact car will still lose the inertia battle with a massive SUV (likely carrying a single passenger).
Vehicles are though, by way of DOT standards, various state regulations and licences... Wanna drive on the highway? That better be a vehicle perscribed for such activity.
I live in the UK, and I love that there are no Rx TV commercials here. Then again, I live in Scotland, and I get my prescriptions for free. The NHS is an incredible service, and it surprises me that most Americans don't want publicly funded healthcare. Even those darn Canadian guys north of your boarder have a good public healthcare system.
BTW, the UK economy spends almost half in, relative terms, at 9.6% of the UK GDP vs the Americans spend of 17.9% of GDP, on healthcare. In real terms (2012 dollars), the UK spends $3480 per person vs the US spending $8362 per person. And we have a health care system free at the point of delivery.
We're 'MURICANS! We don't need no stinking gubmint telling us what doctor we can see! Now let me get down to Walmart on my Medicare provided scooter because I'm too obese to walk... https://www.medicare.gov/Pubs/pdf/11046.pdf
Just so we're absolutely clear, I can choose my own doctors. GP's, specialists, dentists, and even a Homeopath!; if I don't like 'em, I can find another, and all on the NHS. I think, in fact, I have more choice than Americans--don't you have to go to whomever your HMO tells you to use? Also, your Canadian neighbours to the north get to choose their doctors.
1.) There is a very common assumptions in the USA that because a State funds healthcare, the individual is not allowed choice of doctor, which is incorrect in every public healthcare system I have used.
2.) That public or state run health care system is not substandard or less efficient to the American private system, but actually generally better for just about everyone.
3.) That if every American paid a flat 18% tax for healthcare (instead of any healthcare insurance premiums, whether paid directly by you, or by your employer), then the American government nationalised all American healthcare, every American should then receive at least a $4000 tax rebate. Then again your government could use that money fund better schools and universities.
[EDIT] And by-the-way, the UK Government still spends less than the American Government on every citizen, on healthcare. The American government spends $4437 per every single American citizen every year on healthcare. By contrast, the UK spends $2919 per person, every year. You tell me which tax payer is getting better value for money.
Is it? BTW, provision of healthcare in Canada is a provincial matter, so there are 13 separate healthcare systems in Canada. Which one is in collapse? Or are all the provinces facing severe budgetary constraints imposed by the previous Conservative, let's not tax the rich, government.
There are some very powerful, vested interests, namely the insurance and drug companies, that do not want public healthcare.
I am completely suspicious of private, for profit healthcare.
Are you seriously telling me that private healthcare is better? (Okay, private healthcare is better for the maybe the top 1% who can pay for their healthcare out of pocket, but if that is not you, the public system is better.) If I change employer, and therefore insurance policy and/or provider, I will never have to think about previous conditions that may not be covered with my new employer, for instance.
As a physician I can tell you that this type of public reporting has radically decreased the amount of stuff that doctors take from drug companies.
Removing advertising from the TV will do the same. It is much easier for a physician to give a patient the most correct medication without these biases. Remember that in the US, we spend about 2-3X as much as anybody else for less length and quality of life.
I would argue the opposite. By creating a separate class of individual that receives information about medicines we obfuscate what the options are. Under the current model a doctor could say "You should take <x>" and I would have little to no exposure to alternatives" .
IMO the real issue is that advertising (not just pharmaceutical) is not very informative anymore, we need a return to fact based ads. No more "sexy" women draped over whatever, no more saccharine smily women glowing after their husband took <y> ... Ads today are propaganda.
TV ads are not "information about medicines", that's just ridiculous. They are mind-games the advertisers play with potential customers in hope of squeezing more cash out of them.
You want true information? Read peer-review studies.
> Under the current model a doctor could say "You should take <x>" and I would have little to no exposure to alternatives
Right, 'cause doctors are evil like that. I just saw an ad revealing what doctors don't want me to know, I am totally going to believe it!
That we, as a society, allow people deceive us and to lie in our faces, and not only that - we've turned it into an respected occupation - still boggles my mind.
Exactly. That's why we opt for free speech. We allow people to lie and attempt to deceive and spin because we know that it's better for citizens to be accustomed to the marketing and somewhat robust against it than to trust some other higher power that can betray the unprotected and unaware masses.
I don't buy it. I think "we" didn't allow a thing, it's just that lying makes money, money gives power, and power can be used to keep your lying legal (and money can be used to make it be perceived as socially acceptable occupation).
that someone else in our current system are judges. I'm not sure i know of a justice system that doesnt eventually place the burden on a small number of people.
AFAIK systems hoping to discern truth eventually require a cannon.
I guess I'll be the one to go against the grain here. I've seen a lot of doctors over the years, primarily for mental illness, but my experience has served me well generalizing to normal, physical health. The model of a doctor as a paternal guardian who knows better than you so you should just do as he says is a very bad model. They're as flawed human beings as anyone else and the only person qualified to fight for your best interests is you. Doctors get complacent, lazy and fail to keep up with the latest information unless you press them to do so. You HAVE to stay informed and aware to get the best treatment. Ads can serve an important function of informing patients of new treatment options and if doctors could truely be entrusted with your health without question then there wouldn't be a need to regulate these ads at all since doctors would only be perscribing the best treatments anyway. Medicine works best when it's a two-way, active dialog. In my personal experience anyway.
As someone who also has mental health issues, I want to say I agree. However, I don't think ads are the optimal way for a populace to stay educated. Personally, every medication I've been prescribed has been followed by my own research as to how the medication is designed to work.
I will agree though that the relationship between me and my doctor should be a two-way one. I am completely open with my doctor and make it known what i expect out of them, and they are the same with me.
It's not the best solution, but I don't think banning them will do any good. I'm more rebutting the attitude in this thread that medical information is only for your doctor and not you. I don't think you'll get better health outcomes by focusing all of your medical advertising budget on influencing doctors behind the backs of patients. And advertising does serve a legitimate purpose; I knew a woman with restless leg syndrome who had suffered from it for all her life, but a treatment wasn't developed until something like 5 or 10 years ago. She'd have never asked her doctor about it had she not seen the advertising since she had gone without medication for 50 or 60 years at that point.
This is an issue for both doctors and pharmaceutical companies. Doctors hate it because patients may want a drug that's not optimal for them (but I saw if on TV) and it's bad for pharmaceuticals because they've had to become marketing machines, investing massive amounts of money into advertising and sales apps.
The biggest issue with an outright ban is consumer education. Someone, something, or some organization needs to be responsible for properly communicating and educating consumers on a drug, its benefits, and its negatives. It needs to be educational, supplemental, and neutral.
Stuff like this does exist for cancer drugs but should spread to other drug areas as well.
> Someone, something, or some organization needs to be responsible for properly communicating and educating consumers on a drug, its benefits, and its negatives.
We call those people doctors.
> patients may want a drug that's not optimal for them (but I saw if on TV)
A doctor that ever caves to such a request is a terrible doctor.
To be fair, the pharmacists should also be aware of major drug facts and interactions. But by the time you're talking to one of them, you already have a prescription anyway so...
The best reason, in my opinion, is that there are new drugs all the time. The FDA approves on the order of 20 or so drugs per year (that's new drugs, not including new generic versions of old drugs). So physicians have to learn 2 new drugs per month in enough depth to consider how it should change their current prescribing habits.
Even if consumers were informed by some mysterious agency, doctors would still have to learn new things all the time, including which new drugs are appropriate to prescribe for which conditions. Since doctors have to learn that stuff anyhow, and since they already talk to patients, I don't think explaining drugs to patients is a particularly big burden.
For most fields of medicine, new drugs (and not reiterations of previously-approved drugs) are rare. Further, a new drug will have generated extensive hype before its approval, given the requirement for Phase I, II and III trials for most approvals.
I don't think it's at all unreasonable to state that physicians are more than able to track all drugs relevant to their core patient populations.
When there's a brand new drug for your semi-rare condition, your family doctor might not yet know such a drug even exists were it not for you seeing the ad and asking about it.
Family doctors are not likely to be treating a semi-rare condition.
To put it in programming terms, a front-end web developer would seek advice from a networking expert if her or his application was experiencing a lot of networking difficulties.
There are precious few professions that don't require constant skill-sharpening, and if anything, I would expect doctors to be amongst the best at keeping up to date. They spend more time than any of us being formally educated, so the informal self-education necessary to do the work seems like it should be natural.
But I don't know anything about this stuff, and I'd love for someone who does to teach me a thing or two.
I would argue that if you purchase a Health Care & Insurance Service plan from a megacorp, that corporation should be responsible for providing medical education and advocacy services to their customers.
Eg. If you have a plan with Blue Cross, they should have both software and individuals that can advise and be a resource to you. Maybe these are medical students, or some 2 year medical advocacy degree, RN, pharmacist - someone with some experience working/studying in the health care industry. So you go to the doctor and the doctor says, this is my diagnosis, here is a treatment plan, you call up your Health Care Advocate and they review with you as a second set of eyes on the issue. Maybe it all checks out, maybe there is a generic that could save you a ton of money, maybe there is a new drug that works better and your doctor was just going through the motions and isn't up to date on the drugs for your particular issue, but either way, having someone else there to help you get the best care would be a huge benefit, and thus a huge industry opportunity.
Even though many commenters here write about how creepy these ads are, I don’t think many people realize how weird this looks to the rest of the world. The US and New Zealand are the only two western nations which even allow them to exist.
As I am not residing in the US myself, the only experience I have of this phenomenon is in parody form: Progenitorivox!
One of the arguments I've commonly heard against a ban like this is that pharmaceutical companies need to market their products because of the cost developing new drugs. However, this has turned into a strategy of expanding the medical uses of already approved drugs and then marketing the "new uses".
Tylenol is the perfect example of this. Everyone "knows" that it reduces the risk of heart attacks, because of the marketing campaigns. But what most people don't know is how little of an impact Tylenol actually makes.
>"Tylenol is the perfect example of this. Everyone "knows" that it reduces the risk of heart attacks, because of the marketing campaigns. But what most people don't know is how little of an impact Tylenol actually makes."
Furthermore, given that I can buy a a jar of 1,000 low dosage store-brand aspirin for $10 or so, I doubt that the adult use of baby aspirin came about because of a vast pharma-financed advertising campaign.
... Aspirin is what's used to reduce the risk of heart attacks.
It's also a known blood thinner. Pro wrestlers take handfuls of the stuff before matches they're supposed to be bloodied in, then cut their foreheads open with a blade. The blood loss is superficial and controlled, but it makes for drama.
True, aspirin as a daily regime for people with no CVA/TIA (stroke) or cardiac history is of dubious efficacy, but worthwhile of consideration. It is however, certainly not going to alleviate chest discomfort indicative of an impending cardiac event (or prevent said event).
Key question for digital health / biotech startups is whether direct to consumer (D2C) advertising for testing services (e.g. genetic carrier screening; cancer risk screening) would be included.
Great news, so pharma companies could focus more on drugs itself and less on marketing. It's huge money waste with mysterious intention - if your drug is the best, doctors should use it anyway, and if it's bad but you can increase its usage with huge marketing campaign, then mankind just gets screwed for own money.
> if your drug is the best, doctors should use it anyway, and if it's bad but you can increase its usage with huge marketing campaign, then mankind just gets screwed for own money.
That's 100% true for everything - just replace "drug" with "product". As soon as an advertisement is leaving the point of informing about product's existence and features, it's starting to trick people into chosing a suboptimal option.
If people acted like homo economicus, that would be true. But people are so irrational, that sometimes they need to be convinced to do the right thing for the wrong reason, no?
In other words, a given advertisement might be tricking people into choosing the optimal option.
if your drug is the best, doctors should use it anyway
Amazingly that is untrue. Doctors have to know that it's the best drug and they often don't. Doctors are often creatures of habit. If I gave my last patient Crestor and it lowered their cholesterol, why not try the same with the next patient?
> Amazingly that is untrue. Doctors have to know that it's the best drug and they often don't. Doctors are often creatures of habit. If I gave my last patient Crestor and it lowered their cholesterol, why not try the same with the next patient?
What you need is a clinical pharmacist not an advertisement. I am perhaps biased as my wife is a clinical pharmacist and one of her biggest things is to make the doctors use evidenced based practice rather than "this worked before" or "I saw this on TV".
The amazing part is despite actual studies (all readily available on pubmed etc) she gets ignored and the doctor does what he/she wants anyways. Some older male doctors (who perhaps lack some respect) will literally throw the printed out studies my wife brings to them in the trash.
Thanks for sharing that. I think you summed it up nicely. Physicians do have a need for information about new drugs. They simply don't have the time to do the research themselves. That said, the crux of the argument is around how that information is transmitted. DTC seems less than ideal which I can understand.
While I agree with the idea here, it's important to not take it too far. In Canada "advertising to patients" is interpreted to mean almost any communications at all -- including putting up websites with purely informational content. As a patient who sometimes needs information about drugs I'm already taking, this is not helpful. (Fortunately many such websites allow a "why yes, of course I'm a doctor" checkbox to get access to more medical information. But not all.)
I think disallowing "push" advertising while still allowing companies to make information available to patients who deliberately seek it out would be a good compromise.
I'm surprised the AMA, insurance companies or the US government haven't built a simple website that compares the drugs used to treat various conditions to combat the problem of people switching drugs because they are new or are heavily advertised.
While a layman can't be expected to fully understand the benefits/drawbacks/interactions of a drug in detail, it seems like it should be possible to have an easy to understand grid of positives, negatives, retail price, etc. that would make comparing say, the brand new bipolar drug to old generic lithium.
There's a part of me that wants to agree completely...and there is another part that has concerns about the messenger.
The end result of that would be that the gatekeeper to knowing about these drugs or devices are the doctor's themselves meaning those companies just have to work harder to advertise to the doctors to recommend their drug/device.
When I was in the US for most of last year for business this is the one thing that really perplexed me. In Australia the only advertisements we have are for Nurofen and popular paracetamol product Panadol. In the US, things are ramped up quite substantially, ads for blood pressure medication and erectile dysfunction.
I just stopped turning on the TV in the end. These ads seemingly dominate television over there and some of the side effects for those drugs sound horrible, death is mentioned a lot.
One of my parents is a doctor, and I grew up getting a amazing front-row baseball seats courtesy of pharmaceutical sales representatives. Not to mention dinners out at nice restaurants when I tagged along to medical conferences.
Doctors are very good at keeping tabs on earnings of others but have no limits on the estimates of their own value. We in turned are conditioned to respect doctors as the vessels which carry the whole of healthcare. Nothing could be further from the truth. Talk to a very large percentage of doctors outside the office and you find that money is there bottom line. They're all for tort reform so you can't recover a large settlement when they are negligent. They grouse endlessly about how much they have to pay for malpractice insurance. I recently saw a doctor get into a private chauffeured limousine with a vanity plate outside a major NY hospital. I don't know too many pharma execs that live that high on the hog. Did I mention the chauffeur was armed. I guess you can make people angry when you flaunt wealth like that. My own doctor lamented not making as much money as "those wallstreet guys" just before he forgot I was in the hospital for a week. Oops.
Absolutely. US doctors have the highest income in the world. Even our supposedly underpaid GPs have higher salaries than specialists in almost every other country. And the public accepts it, even defends it! Yet our health outcomes aren't any better.
Health outcomes are determined by more factors than the quality of medical care. Obesity (and it's bed fellow diabetes), sedentary lifestyles, drinking & drugs, etc. Given current medical knowledge and technology, no medical system can undo the harm caused by those cultural factors. Doctors' advice is just that, advice that you are free to ignore.
Even more specific metrics can be misleading. E.g. we know that cancer patients are more likely to be cured in the US than in Europe, but there's enough confounding factors to muddle any conclusions. It could be that earlier detection in the US leads to treatment for a cancer that would have gone into remission on its own and never been detected by doctors in another country. Or it could be that US cancer care is superior.
There is that. It is interesting to see how television in particular seems to have lost a lot of advertising diversity, excluding advertising for other shows on the same network, these days just drugs, cars, lawyers, and pay-to-play games, with the occasional movie trailer for good measure. Bad news for television networks.
Yeah - to the point that I can't stand it. I can't even watch football anymore. I generally end up muting the commercials and forgetting to check back when they're over.
I am from the UK. When I first went to the US in the 90s I was shocked to see adverts on TV for prescription meds. Sure I was used to an ad for some "premium" paracetamol in the UK but drugs to treat depression? nerve pain? Etc.
When I released it was the norm I wasn't surprised the US never established an NHS style system. Way too much money to be lost.
Are family doctors able or willing to keep up on the flood of new medicines available, each of which may only apply to a handful of their patients?
Aren't drug ads, in a way, a good method for matching medicines to the people who need them? As far as I know, your family physician isn't going to call you when a new drug comes out that better treats your semi-rare, non-fatal condition - and patients aren't going to read medical journals to discover new drugs to ask their doctor about.
Family doctors are not likely to be treating a semi-rare condition.
To put it in programming terms, a front-end web developer would seek advice from a networking expert if her or his application was experiencing a lot of networking difficulties.
Further, even if your family physician is monitoring the progress of your disease, you'll likely also be seeing a specialist who will also be monitoring the progress of your disease.
> Family doctors are not likely to be treating a semi-rare condition.
Really?
I have family members with rare conditions - for example diverticul(it/os)is, which affects 0.74% of the population - and they don't see specialists. The family physician monitors it. And this is with a "Cadillac" insurance plan.
I don't think every rare condition automatically gets you in with a specialist.
It likely sounds like a rare condition for you and your family members but that particular example happens to be something regularly discussed in first year medical school courses. See [1] for a discussion of how common this is.
Also consider that a family practitioner might easily have 2,000 patients. Thus, she or he will likely have direct experience with diverticulitis.
Further (and this is more inside baseball), your family members would need to be admitted to a hospital if their disease worsens to the point that a standard course of antibiotics won't help.
There might be better examples of 'rare' conditions than this, but the point stands - for any condition where extensive domain knowledge is required, you'll have a specialist involved.
Incidentally, diverticulitis is a very American disorder, likely attributable to our eating habits. You and all other readers should be sure to include fiber in your diet.
> Incidentally, diverticulitis is a very American disorder, likely attributable to our eating habits. You and all other readers should be sure to include fiber in your diet.
The family member in question has eaten a near total vegetarian diet for most of their life, so fiber intake is not the problem in this case.
There is one I see advertised regularly, one of the side effects is "suicidal thoughts, or actions", can you believe that, OR ACTIONS. It's one thing when a pill causes my body to fail and I die, it's quite another to have a pill put me in a state of mind where I kill myself.
Also I have seen recently the words, "these are not all the side effects, see our website for a complete list".
I don't understand your sentiment. Do you think that the drugs you take before do not have this many side effects, including suicidal thoughts or actions? Or do you find it unbelievable these side effects are now required to be spelt out in front of you?
I would not mind keeping them provided that they were required to mention the generic if it exist by name in regular sized print and voice.
Most of the drugs I see are ED/PE related and yes you can get prescriptions.
Still in the end, if we are going to allow untested by the FDA and others supplements to be advertised then why would we block drugs which have passed rigid testing from being advertised. Sorry, that would make zero sense.
Such a ban would probably be damaging to many publicly traded companies (not just in health care, but also media and related) that are large components of the Health Care index funds and even broader market index funds sitting in Americans' retirement accounts... which might make this difficult to accomplish politically. (Aside from constitutionality issues, etc.)
How is it a red herring with respect to political feasibility? (Which you'll note is my point; I'm not arguing anything here about the merit of the idea itself on this basis, except insofar as one counts feasibility as in-scope for merit.)
I wonder if HN community reaction would have been different if the headline was "Doctors want ban on access to information to general public on prescription drug and device."
This community sees the word "advertisement" and flips out. I guess health insurance and medical special interest groups did their homework on how to phrase the argument in their favor.
I'd like to know more about the strategy for disrupting that $4.5 billion gravy train. The pharma industry and consolidated media is going to fight tooth and nail, and our current surgeon general seems too close to the industry to act as the heavy in calling for more regulation, as did his predecessors with tobacco.
I'm trying to understand, but I'm pretty confused. There must be something I'm missing, because it seems that this is an obvious move to the majority of the world, as well as the majority of Hacker News. Could you all help me out? What am I missing?
First, implicit in most of the comments here is the idea that whether you need or don't need a drug is a simple, black-and-white thing. The idea seems to be: if you truly had a need for a drug you'd be going to the doctor for it already, and if you were going to the doctor for it already you'd get the medication. It seems to me there's a lot more nuance. There are many, many classes of drugs that solve problems that aren't obviously "go to the doctor!" kinds of problems. I take a prescription medicine sometimes when I do public speaking. It never occurred to me to talk to a doctor about that problem, because it just seemed like a "problem" some people have and others don't. I happened to find out that this situation is easily treatable online, but I easily could have found out by watching a commercial. And this medicine makes my life significantly better, so that commercial would have been of enormous benefit to me, the consumer.
Secondly, it seems obvious that commercials which increase demand would inflate price. For the class of drugs like above -- drugs that make people's lives better but aren't saving lives or addressing significant medical problems -- why should that not be the case? I pay zero dollars for this drug because I have good benefits. Why should that be? I make plenty of money, and I can survive just fine without this drug. Why should I pay zero dollars for it? Why shouldn't the free market be in play in that situation? If we pretend my insurance didn't pay for this drug, I would be happy to pay a bunch of money for it -- or choose not to pay a bunch of money for it because it's too expensive. It's exactly the same decision I make about food at the store, or a new TV.
I understand that there are many prescription drugs that aren't "casual" in this way. I think it's good for society to do everything it can to grant to citizens a certain level of health, and therefore I'm all for restrictions on how these kinds of drugs are priced. And therefore it makes sense to have restrictions about how these kinds of drugs are advertised. But Viagra? Why shouldn't Viagra be subject to the free market? I'm an ultra-progressive (though rational) liberal here, so I don't really understand what I'm missing. Clue me in!
The doctor has to write a prescription for the drug based on his knowledge and experience the tv add therefore is superfluous and solicitous and Unnessary the add is an attempt push the new expensive drug on the patient and their doctor
As a healthy, single, white male who hasn't had a threatening reason to visit a doctor, This. I probably wouldn't have health insurance right now if it weren't for the Affordable Care Act (even though my employer pays most of it). Sure that could bite me in the ass if something were to happen to me, but I'm comfortable with that risk and have family to help me out. There's no good reason for me to "outsource" my healthcare options.
> Sure that could bite me in the ass if something were to happen to me, but I'm comfortable with that risk
Has it ever occurred to you don't have much control over that risk, and that you are a human being that like every other can become sick for no reason at all?
> and have family to help me out
Has it ever occurred to you that many people in the United States do not have family to help them out?
That's ok because the emergency room has to treat you if you don't have insurance but don't mention single payer or those same people will flip out. Even though those costs are being passed on to the insured int he current setup.
Uncompensated care in the US for 2013 was $85 billion (http://kff.org/uninsured/report/uncompensated-care-for-the-u...). Which may seem like a lot, but it's a drop in the bucket compared to the total health care spending of $3.8 trillion (http://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-h...). The alleged problem of people deliberately not buying health insurance and then freeloading when they get sent to the emergency room just isn't a significant factor. But the ACA cleverly uses that as a pretense to force young and healthy people to pay far more than the fair market value for insurance policies, as a way to disguise subsidies to others.
I am in my early twenties. I exercise regularly, I don't drink to excess, I don't smoke, I eat well, and I don't do any dangerous activities. That means I probably won't break my leg or die of obesity-related conditions.
However, it damn well could be that I could get a disease or condition that no one can prevent. No one has any business pretending otherwise.
It's a nice sentiment, and I wish we could live in such a world. Unfortunately, this approach opens up the field for some rather obscene exploitation of prevalent biases of reasoning that even educated people are susceptible to.
Medical advertisements aren't the problem. The problem is that consumers aren't spending their own money and don't know how much things cost because medical providers can't/won't tell them.
As it is, there are too many distortions. You don't pay for your drugs, your insurance company does. You don't even pay for your insurance, your employer does. So once a year, maybe, you grumble that your insurance premiums (the part you pay, at least) are going up, then the next day ask your doctor about Scrotium.
Also, tying health insurance to employment is a direct result of the Feds wage and price controls of the past. Business couldn't compete in cash, so they went for the next biggest benefit.
Yes, the market works the buyers are the doctors (or organizations with medical expertise such as Surgeon general, Insurance company). They are informed enough to make a transaction with the producer of a drug.
A patient will never be able to make a rational decision when buying a drug. So the market economy clearly breaks down if you ever consider patients to be the customers.
"never" was the wrong choice of word. In general there are many cases when patients are not able to make a rational decision. And rarely, if ever, a better decision than a doctor will.
Most of the time yes, but this is about creating a functioning market. I don't think people can be trusted to create a functioning market for products they sometimes can't set a monetary value on (if they are ill) and sometimes don't understand (because they aren't doctors).
> Britain for instance allows over the counter medicine that's illegal in the US.
I'd guess there is medicine that is allowed over the counter in the US that would be prescription in the US. But the bulk is probably the same.
I fail to see how not being able to tell my doctor he should provide me with a specific prescription medication is detrimental to how I run my life.
Healthcare costs need to be held down, most importantly in single payer systems, but it's quite important in insurance based systems too.
People with addictions don't have preferences in the sense you mean. The nature of addiction is that it subverts and overrides the (delicate) mechanisms of rational choice.
If the principle we live by is maximizing total individual freedom, then I think freedom from addiction has to be part of that.
For that matter, much of the point of advertising is also to subvert one's preferences. So as a believer in individual freedom, I'm in favor of ending corporate freedom to profitably manipulate individuals.
People with addictions don't have preferences in the sense you mean. The nature of addiction is that it subverts and overrides the (delicate) mechanisms of rational choice.
It's an interesting point to discuss. Presumably they did (in most scenarios) have a choice when beginning the drug, but then once addicted, you have a good point. So should we argue that that initial choice was made freely, and that we have no right to use force to break you from that addiction (presuming you aren't hurting or posing a threat to anybody else)? Or should we say that since you aren't truly making willful decisions, then intervening isn't violating your personal notion of agency, and going "against your will"?
I'd have to give this one some more thought to be honest. It strikes me that it isn't a simple question. OTOH, I still have no problem saying that anyone who is free to make conscious, willful decisions (whether we consider than rational or not) should be free to make the choice to put anything in their body that they want.
I have yet to meet the person who, when asked for the reason for their decision, replies "it was irrational". The truth is that people take the action they feel is the most rational, and there are many factors influencing that conclusion.
It's also important to consider that addiction is far more complicated than a dependance on a biochemical reactions to a stimulus. There are strong psychological issues at play as well. If we were to outlaw every addictive substance or action, surely no form of entertainment would remain legal.
A person always has a decision to engage an addiction. Deciding to not be addicted is the foundation to recovery. This choice cannot be removed at any point in a person's life, be it before, during, or after an addiction.
To say that an addict is not making decisions is like saying that someone you disagree with is not thinking. Just because you don't like their opinions or their behaviors does not justify denying their freedoms.
I think I agree with you, but I'm willing to consider that there might be a bit more nuance to the issue. Like I said, I'd have to think about it more to be sure (that is speaking only in regards to somebody who already has an addiction).
But overall, I am still for complete legalization of all drugs, as I still hold that a consenting adult has the right to put any substance in his/her body that he/she chooses.
I would also oppose a law restricting the advertising of prescription drugs. But, then again, in my world, the distinction between "prescription" or not would be a lot fuzzier anyway. It might even disappear altogether.
My general way of balancing this is not the allowed/forbidden model, but more the public health model, including things like licensing and insurance.
For example, I think people should be free to play all they want with explosives. But given that explosives are subtle and dangerous, I think it's reasonable to require that people using them be licensed, including extensive practical exams, and that they be properly insured, which may include insurance company inspections and the like. They're welcome to make the choice to light any given fuse, but given the potential consequences it should be an informed, responsible choice that has fully accounted for the consequences.
That's doublespeak. "In order to be free, you must not be free". And very few people are even remotely rational in the first place. And there's little irrational in choosing opiates (long term effects are not nearly as bad as many other things deemed acceptable).
See: tragedy of the commons, positive externalities, etc. etc.
Even the most staunch libertarian has to agree that personal choices which negatively effect society must have some sort of curtailing policy to make whole those effected
Over and over people on HN come to the defense of advertising. Doctors tend to be Republican and free-market adherents. So why would they be against drug advertising?
"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"- Upton Sinclair
> Doctors tend to be Republican and free-market adherents.
This was based on an outdated[1][2] understanding and personal experience (my father is a physician and nearly every physician I knew supported Reagan). I retract.
> Over and over people on HN come to the defense of advertising.
I know this because in my comments here I frequently criticize the role of advertising on the internet and society in general. The downvotes are many. Not everyone defends ads, but many do, and my comment is directed at them.
Here's one thread[3]. I can't spend more time on this, so if you guys still don't believe me, you win (for the moment). I'd rather you were right anyway.
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[2] "The percentage of contributions that doctors have given to Republicans has mostly declined since 1996. It dipped below 50 percent in 2008 before rebounding in 2010." "The study attributed the partisan shift to an increase in female physicians and the shrinking number of doctors running their own solo and small practices." http://www.nytimes.com/2014/06/03/upshot/doctors-arent-stron...
> my father is a physician and nearly every physician I knew supported Reagan
Reminds me of a pretty interesting post by Yvain[0]. The relevant quote:
"There are certain theories of dark matter where it barely interacts with the regular world at all, such that we could have a dark matter planet exactly co-incident with Earth and never know. Maybe dark matter people are walking all around us and through us, maybe my house is in the Times Square of a great dark matter city, maybe a few meters away from me a dark matter blogger is writing on his dark matter computer about how weird it would be if there was a light matter person he couldn’t see right next to him.
This is sort of how I feel about conservatives.
(...)
What I mean is – well, take creationists. According to Gallup polls, about 46% of Americans are creationists. Not just in the sense of believing God helped guide evolution. I mean they think evolution is a vile atheist lie and God created humans exactly as they exist right now. That’s half the country.
And I don’t have a single one of those people in my social circle. (...)
I live in a Republican congressional district in a state with a Republican governor. The conservatives are definitely out there. They drive on the same roads as I do, live in the same neighborhoods. But they might as well be made of dark matter. I never meet them."
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> Here's one thread. I can't spend more time on this, so if you guys still don't believe me, you win (for the moment). I'd rather you were right anyway.
Hah. An advertising-bashing thread I missed :<. I post a lot of negative comments about advertising too, and the reactions are... mixed. I have an impression that HN is a bit split on the issue, some believing that it's absolutely necessary and others (like me) who would say "good riddance" if all ad-supported web sites disappeared right now. But I don't feel like there's a HN consensus around ads.
Likewise no one I spend time with are creationists, but the Internet acts as an inter-dimensional gateway, connecting me with creationists with whom I schooled as a child, and the die-hard you-get-what-you-deserve libertarians here.
I'm writing a treatise on advertising and the internet, or at least I'm trying. I might hit you up for feedback. It may be a while.
Please do, I'll be happy to give you feedback. I'm also gathering my beliefs on this topic myself.
I find myself repeating so often, and being asked the same questions so often, that I decided to write down and maintain a description of my current beliefs on most frequent topics - to serve both as a FAQ for someone asking and as a collection of points and citations to quote.
I'm in the process of writing stuff down, but I still haven't figured out what would be the best way to publicize it. I'd like something that would show the current state of article, but would also allow to easily view the changes over time (as my beliefs get updated based on evidence). Sort of like more streamlined Wiki, or Wiki meets Github meets Etherpad or sth.
They are the creepiest thing ever on television. The actors sit around dinner tables with family members speaking unnatural, FDA manipulated dialog ("Oh, I'm doing great, I've been taking Pradaxa for my afib, not caused by a heart valve problem!") Then you get the unending list of side effects read aloud ("death" almost always one) while the actors smile and stare off into space.
Occasionally, one of these ads will come in a 2 minute and 30 second variety that fills the entire commercial break.
A regulation I'd like to see is that all the side effects must be acted out in the commercial as they are read. Show the peacefully sleeping woman suddenly awakened, choking on her swelling tongue. Or a man running around with an actual 4+ hour erection.