Last weekâ€™s congressional hearings on direct-to-consumer advertising were, as expected, pretty inconclusiveâ€”but that doesnâ€™t mean we wonâ€™t be hearing a lot more on the topic. The big question, I think, is when (and whether) the debate will ever get to the point of realism about what DTC is and can be. The idea of advertising as serious, balanced education about a condition and its treatments is mostly absurd, though some individual campaigns have achieved striking success. The idea that risks and benefits should somehow represent a fifty-fifty mixture makes no senseâ€”unless youâ€™re trying to guarantee that patients avoid the drug entirely (as some critics clearly wish).
Perhaps the most sophisticated critique is that drugs shouldn’t be widely promoted until they’ve been on the market long enough to ensure that risks are understood. But there’s a big question there too: Can we truly discover useful information about real-world risks without exposing patients to risk?
Ads should be accurate, but in the long run the real issue is whether they drive appropriate or inappropriate prescribing. And despite the analysis DTC has been subjected to, thatâ€™s apparently not yet known, or even likely to be known.
In the meantime, one of the great pleasures of grubbing through congressional testimony is the discovery of fascinating, quotable tidbits. Here are a few from the DTC hearing:
“Why should consumers know about risks? There are many views about this question. For example, the 1938 U.S. Federal Regulations say that, ‘Drug [information] should be [provided] only in such medical terms as are not likely to be understood by the ordinary individual.’” â€”Ruth S. Day, Duke University
“We commissioned a Harris survey that found that, prior to our advertising [for Vytorin], just 16 percent of people were aware that there were two sources of high cholesterol. In the year following our advertising, we found that a full 54 percent of people now understood this. We also learned that our advertising had helped relieve the guilt people often carry when they are unable to control their high cholesterol with diet and exercise, and encouraged them to have discussions with their physicians about additional options for controlling their cholesterol.” â€”Deepak Khanna, senior vice president and general manager, Merck/Schering-Plough Pharmaceuticals
“We know from our survey data that prescription drug ads are doing what they are designed to doâ€”prompting people to talk to their doctors about a specific drug they saw advertised. Many go on to receive a doctorâ€™s recommendation for a prescription as a result. What we donâ€™t know is what share of those people were already under a doctorâ€™s care for that particular condition and were asking about a new drug, how many were prompted by an ad to get needed care for a condition they hadnâ€™t discussed with a doctor before, or how many may have been seeking unnecessary medications. These questions go beyond the scope of what can be captured in a survey of the public.” â€”Mollyann Brodie, vice president and director public opinion and media research Henry J. Kaiser Family Foundation