Billions Spent Marketing Drugs to Consumers
In
the two years since the FDA began an experiment to let the mass media broadcast
the prescription-drug message directly to consumers, the pharmaceutical industry
has shelled out a whopping $1.3 billion per year on consumer ads. That dwarfs
the $763.6 million spent on beer ads, says Competitive Media Reporting. This
figure may or may not be accurate, as we all know from the little, but important
book, "How to Lie with Statistics." (Copyright 1954) Disraeli said
"There are three kinds of lies: lies, damned lies, and statistics". So
common sense has to reign. As of August 2, 2999 there were 34 drugs advertised
to the public on television.
Why
does the world's best-selling drug, the heartburn medicine Prilosec, cost $3.30
a pill in the United States but only $1.47 in Canada? Why does Claritin cost
almost $2.00 a pill in the United States but only 41 cents in Great Britain? Why
does the United States have the highest drug prices in the world? To begin,
every industrialized country with the exception of the U.S. imposes some form of
price controls on prescription drugs. Additionally the American consumers
literally pay the price to subsidize research and development for the world as
well as the pharmaceutical industry's substantial profits. Fortune magazine
ranked the pharmaceutical business as the most profitable of all industries in
1998 when measured by returns on equity, sales and assets.
Why
do TV ads seem so convincing? What is it that they do in the 60 or so seconds
that makes people act on this information? Maybe the television commercial is
not about the product at all, but rather the character of the consumer. What the
advertiser needs to know is not what is right about the product but what is
wrong about the buyer. I have heard many well-educated friends and relatives
say, "I saw it on television so it must be right." In 1998 an
estimated 55 million people talked with doctors about prescription medicines
they saw advertised, and doctors wrote prescriptions 84% of the time they were
asked, according to a Prevention magazine study. The television commercial has
"embedded in it certain assumptions about the nature of communication that
run counter to those of other media, especially the printed word." The
commercial is unusually short - an instant, always addressing itself to the
psychological needs of the viewer. It may be considered instant therapy. As Neil
Postman said years ago in "Amusing Ourselves to Death" "The
commercial asks us to believe that all problems are solvable, that they are
solvable fast, through the interventions of technology, techniques and
chemistry." Of course this is preposterous, yet I hear it over and over.
"It must be true otherwise it wouldn't be on television." I would
rather hear "It certainly is wrong and oversimplified, and that is
precisely why it is on television. The USA is the only industrialized nation
that permits prescription drugs to be advertised directly to consumers through
television commercials and print ads. High U.S. prices are coming under
increasing scrutiny because prescription drug costs are the fastest-growing
segment of health care costs. Since 1993 they have risen at a 12% annual rate.
There seems to be a cure for everything: allergies, ailing hearts, depression,
herpes, high blood pressure, premature hair loss, headache, impotence, and on
and on. The most expensive drugs are advertised, not the generic ones of course.
But doctors face pressure from their HMO companies to prescribe inexpensive or
generic drugs to hold down costs. "I could be de-selected by an HMO or
managed care program. Is that a conflict of interest?" said Dr. Thomas
Kowalski a Milwaukee pediatrician. I think the answer is obvious
According
to Health Affairs a leading policy journal "Advertising prescription drugs
directly to the consumers may be harming the quality of clinical care" and
upsetting the delicate doctor/patient relationship, if there still is one. In
Health Affairs Michael Wilkes, MD and colleagues write that these ads" may
cultivate the belief among the public that there is a pill for every ill and
contribute to medicalization of trivial ailments, leading to an even more
'overmedicated' society." This type of advertising rarely mentions
lifestyle changes and nonpharmacologic interventions. TV ads are for the most
expensive pills. The consumer really has no choice if there is one particular
medication available for his or her condition. The cost of running ads adds to
the price, and companies are currently seeking to extend their patents longer to
make sure that generics do not compete.
New
travel spin offs have had success as seniors join groups to travel to Canada and
Mexico. For $99, RxPassport provides a seat on the bus, pays the Canadian
doctor's fees, helps patients fill out the paperwork for their prescriptions,
and includes a gourmet box lunch on the return trip. The office, set to open in
a month, is ready to deal with up to four busloads of American patients every
day. Dr. Paul Zickler, the managing partner of RxPassport, stresses that the
office is not a clinic. Although a nurse will be present, patients will not
receive exams. Prescription requests must arrive with a letter from the
patient's primary care physician or specialist before the visit. If the Canadian
doctors find no problems, they will rewrite them, have them filled and give them
to the patients when they arrive. Customs allows only a 30-day supply to cross
the border. The majority of the patients will be seniors "and the
medications that they're on are primarily high blood pressure pills, diabetic
pills, heart pills."
American
prices for prescription drugs are the highest in the world so it is not
surprising that people will travel across borders. The United States actually
does have a price control system similar to other countries but it applies to
only one customer: the federal government. Pharmaceutical companies are required
by law to sell drugs to the government at the best wholesale price given to
their large U.S. customers. Then, the four biggest federal customers - the
Veterans Administration, Defense Department, Coast Guard and the Public Health
Service/Indian Health Service - get an additional 24% discount. This essentially
gets international prices for the federal government. But these four markets
account for only 1.5% of the U.S. market.
Annie
Ryman, a retired nurse in Bay City, Texas, won't shop for cheap drugs in Mexico.
"Her doctor told her not to because some of her medicines have very precise
formulations. So she copes with the high cost of prescription drugs by skimping
on medicines. She cuts some pills in half and ends up taking only half the
prescribed dose."
One-third
of the elderly have no prescription-drug coverage, and many of those with
insurance have high deductibles. A great many folks do not even know if they are
in an HMO or not. They are not aware of the caps on prescription coverage that
limits them to $1,000 to $2,000 a year.
On
the program 20/20 (ABC) about statins, used to control cholesterol levels Dr.
Tim Johnson and Barbara Walters advised everyone to take this medication
prophylactically, every day. This makes no sense at all. Even if the plaques
that cause heart attacks are hidden, taking a medication every day, on the off
chance that an attack could be staved off, would not make good medical sense and
would cause wear and tear on the liver. It does make good business sense, and
that is as usual the bottom line in the good old USA.
Dorothy
Guellec guellec@purvid.purchase.edu member Foreign Press Ass'n
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