Don’t blame the ads, you’re writing the scripts

Direct-to-consumer drug advertising might seem egregious, but the onus is on you, the EP, to make the call. 

We’ve all heard the commercials. Whether it’s to cure erectile dysfunction, insomnia or restless leg syndrome, it’s always, “ask your doctor about . . .”. This flood of direct-to-consumer drug advertising isn’t going anywhere, and it begs the question: What should be the response of organized medicine? The answer, as it turns out, goes to the heart of medical economics and what it means to practice responsible, ethical medicine.
As a young man in medicine, one would have never expected to see prescription drugs advertised on television. This is strictly a phenomenon that began in the 90s and has accelerated without fail. Why do drug manufacturers and health product manufacturers do this? Because it works, stupid! If there wasn’t a financial return on the investment, they wouldn’t do it. They have created their own demand. The question is, do we believe that the American public is so stupid, and American physicians so spineless that they cannot respond to this problem. I think that the biggest problem is not that patients come in asking for a specific drug, but that physicians don’t have the courage to look those patients in the eye and say, “No, you don’t need that,” or “No, there are other complications.” It is always interesting to note that the side effects, complications and untoward problems are always given short shrift in the advertisement on TV. The blurb at the end where it rushes through the fact that you could take two of these tablets and die, is never given an adequate open or honest discussion. Neither is the simple question, do you really need this drug? Take Viagra, for example. Without belaboring the issue, it is a philosophical question when health plans are paying for drugs – including the various programs of the federal government – how many erections a year should you be guaranteed under the constitution?
There is very little to recommend most of the drugs being advertised on TV. They tend to be fringe drugs. The reason is that if they were mainline, mainstream, their use would already be established. It is when there is a close call as to whether the effect is worth the side-effects that the drug companies tend to enlist the help of the public in demanding this latest of technologies.
As a good economist, I am loathe to get into the business of limiting advertising. I don’t really care how you spend your money. The real problem is that as physicians we are stewards of the public trust. How tests are ordered, how drugs are given out, all comes back to a basic ethical question. Are we tasked with simply looking after people’s health, or are we also guardians of the general health and financial welfare of the system?
Advertising has been going on since there were more than two humans on the earth. You will not stop advertising behavior, nor should we. But what we need to do is make sure there is a conditioned, seasoned, well thought-out response to each of these requests. It would be worth it for organized medicine through the AMA to review every one of these commercials and send out a response, or have one available online, to carry on an intelligent conversation with the patients. The fact that they are asking for the drugs is not the problem. The problem is that we are answering by writing a prescription. Until this behavior stops, we will not have established ourselves as the true leaders of the health care system in the United States.



  1. Dr Sourbutt on

    I think RLS and Overactive bladder are indeed Big Pharma concoctions…also ” imagine knowing the exact moment you are pregnant!!”

  2. J. DeLaughter, DO on

    I’ve never been a fan of direct to consumer (DTC) ads. They are frequently so bereft of information that they border on fraud. The only reason they get away with it is that they always have the disclaimer at the end: “Talk with your health practitioner about ‘xxx'”

    You are right, in that most of the drugs in these ads are the so-called “me too” drugs, where the company changes a molecule on the base medication and so get another 7 years of patent exclusivity, but they have to get the word out about their new “breakthrough” medication.

    And we, as physicians, just continue to shill out the prescriptions for the latest and greatest pill.

    I try not to, for my part.

  3. Not sure I get the drift of your argument. Are you saying that physicians are facilitating the rapacious price structure and marketing practices of Big Pharm?
    For myself, 80% of my scripts are still cephalexin,zithromax, darvocet and ibuprophen. As individual prescribers with very weak political represention, we really have very little leverage against the billions the pharmaceutical industry rakes in each year.
    The real issue is Big Pharm lines the pockets of both sides of the aisle in Congress, so as per most problems in our “democracy”, our leaders do what their PACs obligate them to and not what is needed by the country to solve a problem. Any effort by the AMA, etc., to counter their ads would be blown out of the water by vigorous ad campaigns. Physicians and esp. their professional organizations lost the political battle years ago. To say that physcians could counter a slick Hollywood researched and produced commercial with individual counseling, I think, is a bit pollyannish.
    The real answer to huge drug bills a few years ago was to open the borders with Canada and Mexico and see just how many multiples patients can reduce their monthly drug bills. Notice both parties proferred the drug companies’ disinformation campaign that people would be dying in the streets from toxic fake drugs. I’m sure you, like myself, have seen countless news items in recent years about people in Canada and Mexico dropping dead from taking homegrown pharmaceuticals. If you ever visit a border town crossing into Mexico, half of the buses crossing are seniors on Medicare loading up on much cheaper pharmaceuticals.
    Big Pharm has a monopoly here,and they protect it zealously. The argument that their profit margin is needed for research is also disingenuous – as the doc above notes, the majority of drugs drilled at us by the pharm reps are “me too” drugs with a molecule changed so they can keep the patent another 7yrs and the monthly price over $100. Note too, a US source is no guarantee of safety. Recall Tequin, Tamiflu and the other recurrant emergency “notifications” about prescribing you get each month.
    The problems is not the docs, it’s the political system in this country. It’s run on money and not counseling or common sense. Canadians calls us the “United Steak”, and it’s not really a compliment.

Leave A Reply