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Buying the Pharm

by Julia Sneden

Well, there they were on the nightly news again the other evening, announcing (surprise!) that seniors are having trouble paying for prescription drugs, and bemoaning the fact that nothing has been done to get at the heart of the matter, and wondering why Congress hasn't been able to pass —if not a universal health plan — at least a better plan to make prescription drugs more affordable.

It seems to me that rather than looking to our government to underwrite the higher costs, we might do better to consider encouraging our government to stop the drug companies from engaging in what they call DTCA: that's Direct to Consumer Advertising. It takes only a modicum of common sense to realize that in their efforts to push new drugs at us, American pharmaceutical manufacturers run up HUGE advertising expenses. And guess who bears that cost? You and I, that's who.

In 2000, the drug industry spent 15.7 billion dollars in promoting drugs, according to a consulting group called IMS Health. The largest amount was spent on free samples to physicians, but billions were also spent on gifts to doctors, and hiring 83,000 sales people for television and other advertisements.

Fifteen years ago, drug companies advertised prescription drugs only to doctors. Their methods included providing free samples, or office equipment (such as calendars, note pads, scales, etc.) emblazoned with the name of the medicine or its manufacturer, or "vacations" where the doctors and their families spent a few days in a glamorous spot, at no cost except for the obligation to listen to the sponsor's short message.

In 1980, two drugs from Boots Pharmaceuticals, Rufen , and then Pneumovax , appeared in print advertisements. In 1983, the FDA imposed a voluntary moratorium on DTCA, but lifted it in 1985. Prescription drug ads began to appear in all the major magazines and newspapers.

Once that dam was breached, it was only a matter of time until such ads hit the television screens. In 1997, the FDA began working with the drug companies to see whether they could meet the advertising needs of the manufacturers while also pushing their products to the public in what was called a "responsible fashion." It was decided that such ads would have to list the risks inherent in taking the drugs; provide an 800 telephone number for added information; or list a website; or advise calling health care professionals to check on attendant information.

Soon, pill-pushing advertisements began popping up everywhere. Particularly unappealing are the ones that come on during the nightly newscasts, right around the dinner hour.

Have you noticed the advertising ploys that are used to get around the required warnings? "Possible side effects" are delivered in a very rapid, expressionless burst of speech, sandwiched in between the initial jazzy plug and a final, feel-good statement. The wording is also worth noting. Some spin genius came up with the strategic injection of the word "only," as in "only diarrhea and edema occurred more often with (the drug) than with a sugar pill." Only? What's "only" about spending a day running to the bathroom, or watching unnamed body parts swell up? And what about the mellow-voiced woman who skips lightly over "sexual side-effects may occur" without telling us whether she's referring to impotence or vigor?

Unfortunately, despite their incredible turnoff factor, these ads work. Americans spent 22 billion dollars more on prescriptions in 2001 than in 2000. A study done by the FDA reports doctors claiming that during visits from patients, one quarter requested a specific brand of drug. Of those requests, 69% received the drug they asked for.

Some consumer groups have openly applauded Direct To Consumer Advertising, saying that it educates the public about new medicines, and also about the dangers involved. (I feel constrained to point out that you can find out lots more by reading the "scoop sheet" that pharmacists give out with each prescription).

Health care professionals tend to be negative about DTCA, citing the increased amount of time a physician must spend with a patient who asks for a specific drug as the doctor explains why the drug is or is not pertinent to the treatment of the illness involved. In other words, a semi-informed public slows things down.

Managed Care companies dislike DTCA because it increases the public's consumption of more expensive prescription drugs, as opposed to generics. They also point out that the newest drugs are not always safer or more effective than older, less expensive medications.

The Canadians have done a study of America's DTCA that's a real eye-opener. Their conclusion? Advertising doesn't provide the impartial, objective information people need to make informed decisions about their health and treatment. Its main goal is to increase sales.

Our newspapers tell us that drugs cost more in America than in other countries. A 1998 Congressional Study found that "drug manufacturers appear to be engaged in cost shifting, charging low prices in Canada and Mexico and recouping the differences with higher prices to US senior citizens."

People 65 and older make up 12% of the US population, but consume 35% of all prescription drugs. The average over-65 fills nine to 12 prescriptions per year, compared with two or three for people between 35 and 44.

The pharmaceutical companies claim that advertising helps to offset their research and development costs. We can't help asking: who paid for those costs before DTCA came on the scene? There were surely a great many drugs researched and developed without television advertising to pay for them.

The chairman of an AFL-CIO task force on prescription drugs notes that the pharmaceutical industry spends over three times as much on marketing as it does on research and development.

More than 15 states are considering bills to control drug company promotions and ads. For example:

Vermont has enacted a bill requiring drug companies to see that their sales representatives report all gifts to doctors that are worth more than $25 (but free samples and scholarship contributions are allowed). The bill puts the representatives in the same category as lobbyists and politicians. The governor, who is a doctor, says that physicians cannot help being swayed by aggressive marketing.

Vermont has also offered a Joint House Resolution calling on the FDA to institute a moratorium on DTCA.

Hawaii saw a bill signed last month that requires disclosure of annual drug advertising budgets.

The Kentucky House of Representatives has passed a bill calling on the federal government to limit DTCA.

In Portland, a 100-doctor practice has banned most drug company representatives from its offices, as well as branded clocks, note pads, etc.

When drug industry observers are asked about the cause of the dramatic increase in the cost of prescription drugs, they site:

increased prescribing and accessibility for a growing US population
the increasing number of senior citizens
new generations of more expensive medications entering the market at a faster rate
increased advertising budgets

Some things in the above list don't make sense to me. Shouldn't increased prescribing and the increasing number of senior citizens mean a larger market, and thus more income for the drug industry? Don't increased advertising budgets pay for themselves and increase profits, too?

It seems to me that senior citizens would be well advised to bombard Congress with the list of our discontents. Bearing the costs of prescription drugs at the highest rate in the world is bad enough, but bearing costs at a rate disproportionate to the younger population of America is despicable. Consider, for instance, that the elderly are often on fixed incomes predicated on pre-inflation amounts, and that the younger consumers are operating on inflation-adjusted salaries.

For that matter, consider that other industries offer their best customers respect and gratitude, and sometimes even discounts!

If the drug industry sees us as irrelevant old poops who will soon die off, they will continue to take advantage of us. They need to be made to see us as a vital, vibrant, important market (which God knows we are). As a group, seniors are endlessly renewable. The oldest of us die off quite regularly, but there is a steady supply of others who slip into our ranks and are shocked to find themselves suddenly termed "senior citizens." Those ranks are growing with the numbers of Baby Boomers approaching 60. If we stand up and stand firm, we will be taken seriously.

Let's put pressure on Congress to discontinue DTCA by the drug companies. Let's insist that the pharmaceutical industry stop recouping price differences by overcharging American seniors.

We don't need a handout from our government. We do need its help to put a stop to the drug industry's disgraceful behaviors.

Writing Congress:

North Carolina's Senator (D) John Edwards on medication costs: Rising prescription drug costs are hurting us all, and it's time to rein them in


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