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:
· inflation
· 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: Congress.org
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
