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Tuesday, March 28, 2006

De-regulating advertising
Speaking of deregulation, think about what a disaster Direct To Consumer Advertising (DTCA) for prescription drugs has been. The only countries in the world stupid enough to allow drug companies direct access to consumers are the US and New Zealand (which is now working to re-ban DTCA), and our drug costs and spending on prescription drugs have skyrocketed compared to costs in the rest of the world. There is an interesting, and accessible free article this month in PLoS medicine on the subject. Here are some highlights:


DTCA is limited to drugs that are profitable to advertise: mostly expensive, new drugs for long-term use for common indications. Such advertising increases premature rapid uptake and overuse of new drugs before flaws, including safety problems, have been discovered and communicated to health professionals [21,23,24]. Many new drugs are inferior to older treatments, and over two-thirds are no better but are often more expensive [25]. Increased use of new drugs stimulated by DTCA can lead to adverse events directly (for example, cardiovascular events associated with COX-2 selective inhibitors, which were heavily advertised to the US public) [23,26,27] or indirectly, by diverting resources from more cost-effective interventions.
...
DTCA aims to persuade rather than to inform, and there is evidence that it is effective at persuasion [12,21]. Content analyses of DTCA have found that the information provided is usually flawed and incomplete [28-32]. Examples include a study of 320 drug advertisements in popular US magazines that found that the advertisements rarely provided information about success rates of treatment or alternative treatments [32], and a study of 23 US television advertisements for prescription drugs that found that the majority gave more time to benefits than to risks [28].

Such advertising can lead some people to falsely believe they are well informed, so it reduces their motivation to search for more reliable information. Finding reliable information is already difficult (like finding a needle in a haystack) and the "noise" of DTCA just makes the haystack larger.
...
DTCA rarely focuses on, and tends to drown out, high-priority public health messages about diet, exercise, addictions, social involvement, equity, pollution, climate change, and appropriate use of older drugs. Older drugs are less profitable to advertise because a share of the sales stimulated goes to generic competition. Consequently, DTCA for any currently advertised drug will become less profitable after expiry of patent protection from competition.When DTCA no longer provides competitive return on investment, it is stopped. Consequently, if there are any benefits from current DTCA (such as stimulating new requests for statins after a myocardial infarction), those benefits will be for a limited time only.


Pretty damning article if you ask me, it dismisses every single positive argument for DTCA as being overwhelmed by negative consequences. Why do we allow drug companies to make their bullshit commercials again? You know, commercial speech is not protected like other speech. It is acceptable to limit, regulate or even ban it, especially if it is deceptive at which point it is no longer speech and is instead called fraud.

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