Talk with your doctor… It's a common chorus at the end of any advertising campaign or disease awareness. In appearance, this seems to be a responsible suggestion. Talking with your doctor can help determine if a new drug is really effective. is for you or if you may be suffering from an undiagnosed disease. Do not just believe the pharmaceutical company behind this ad or awareness campaign, of course.
But the suggestion of consulting your doctor may not be as innocent as it seems. The pharmaceutical company has probably consulted your doctor first.
Of the approximately $ 30 billion that health care companies now spend annually in medical marketing, about 68% (or about $ 20 billion) is intended to persuade doctors and other health professionals – not consumers – benefits of prescription drugs. This is apparent from an in-depth analysis published in JAMA this week. The study revealed in detail how health companies had convinced us to spend huge amounts of money on care between 1997 and 2016. During this period, health care companies went from $ 17.7 billion to $ 29.9 billion. dollars in medical marketing. At the same time, US health care spending reached $ 3.3 trillion, or 17.8% of GDP, in 2016.
The discovery that pharmaceutical companies spend most of their marketing on charming doctors is not surprising, however. In 1997, according to the analysis, 88% ($ 15.6 billion of the $ 17.7 billion) of medical marketing was meant to convince doctors. And the way pharmaceutical companies woo doctors has not changed much either. They do this primarily by sending sales representatives to doctors' offices for on-site visits, providing them with free samples of drugs and other promotional items, providing payments for speeches, food and beverages, travel and organizing an "education" on diseases.
The novelty – and this is why it is now a darker situation – is the explosion of DTC marketing (Direct-to-Consumer) that adds to the efforts of two-way marketing. DTC advertising has more than quadrupled in the time available for analysis. That is, the money spent on TT – mainly television commercials and glossy ads – went from $ 2.1 billion in 1997 to $ 9.6 billion in 2016. Of this amount, approximately $ 6 billion was intended for the marketing of prescription drugs.
This explosion of DTC commercials "increases the need for clinicians to help patients understand claims, medical needs, costs and non-medical alternatives," according to health policy experts Selena Ortiz, of the Pennsylvania State University, and Meredith Rosenthal, of Harvard. In an accompanying editorial of JAMAThe pair notes that this increased reliance on physicians may be fraught with difficulty because doctors may be biased and misled by marketing, as consumers have discovered earlier research. This "suggests that professionals may need additional training or support to serve as a referee in deceptive marketing," they write.
In the end, "trust in doctors and health care institutions may be at stake if medical marketing … continues to grow unchecked," they conclude.
The authors of the analysis – Lisa Schwartz and Steven Woloshin, health policy experts in Dartmouth – point to a particularly worrying practice of the "find a doctor" function in certain advertisements. These features "help consumers locate prescribers, an approach that has raised ethical questions by creating a conflict of interest over whether prescribers serve patients or businesses," they write. As examples, they note the Contrave weight loss drug website and Addyi Hypoactive Sexual Desire drug, which encourage potential patients to plan telemedicine visits to "carry out your medical consultation in the near future." 'privacy of your home'.
Even without these clear links between doctors and companies, DTC's marketing and awareness campaigns have an obvious influence on patients and prescribing practices, note Schwartz and Woloshin. A 2005 study found that patients were twice as likely to be prescribed an anti-depressant or an adjustment disorder if they simply told their doctor, "I was watching this TV program about depression in myself." asking if you thought that a drug could help me "What if they did not say something like that (76% vs. 31%).
In addition, the authors point out that concerted marketing campaigns are even more powerful and that the devastating epidemic of opioids that is raging across the country is a good example. In the 1990s, while drug industry representatives misled health professionals about Oxycontin's potential for abuse and encouraged the unauthorized use of the powerful painkiller, the manufacturer of the drug, Purdue Pharma, launched aggressive awareness campaigns and educational programs on opioid treatment, non-cancer pain. Between 2000 and 2015, opioid prescriptions and the number of overdose deaths quadrupled. The Centers for Disease Control and Prevention now estimate that about 46 people die each day from an overdose of prescription opioids.
With the risks clear, Schwartz and Woloshin examined the regulatory activity of the Food and Drug Administration, the Federal Trade Commission, and state attorneys general. They found a dull response to the skyrocketing medical marketing in all areas. In fact, the FDA's Office of Prescription Drug Promotion, which regulates promotional materials for consumers and professionals, has seen a decline in regulatory activity. Although the number of submissions increased from 34,182 in 1997 to 97,252 in 2016, the number of offense letters increased from 156 to 11 in those respective years. The finding "suggests the possibility of less oversight," conclude the authors, perhaps because FDA reviewers might be "overwhelmed by the dramatic increase in the number of promotional submissions."
In all, Schwartz and Woloshin conclude that "despite the increase in commercialization in 20 years, regulatory oversight remains limited."
JAMA, 2018. DOI: 10.1001 / jama.2018.19320 (About the DOIs).