PLoS Medicine continues to show that public journals not only are a superior method of publishing scientific papers but also serve the public better by presenting unbiased, and often unpopular views, in a forum accessible to all.

This month, it is a series of 11 articles exposing efforts by drug companies to exaggerate and redefine diseases to increase their revenue. The London Times has a lay article on these papers.

And why are drug companies able to do this? Well, direct to consumer advertising (DTCA) of course, (see this article as well). This is a problem mostly confined to the United States of course, mainly because we're the only country on earth stupid enough to allow DTCA (New Zealand is in the process of abandoning the process again). Here's PLoS' take on the problem of letting markets justify patient care:

Because illness is one of the most tangible forms of suffering, the pharmaceutical industry, more than other industries, can link its marketing activities to ethical objectives. The result is a marriage of the profit-seeking scheme in which disease is regarded as "an opportunity" to the ethical view that mankind's health hangs in the balance. Marketers and consumers in the West to some extent share a common vision of needs and the terms of their satisfaction. This apparent complicity helps even the most aggressive marketers trust that they are performing a public service. Pharmaceutical company managers that I speak to signal this when they characterize their engagement with the public as "doing good while doing well."

These managers also see nothing wrong with integrating doctors, patients, and other players into the drug distribution channel. On the contrary, they say, this is state-of-the-art management, making it professionally principled and tactically astute. Marketers also regard the incorporation of consumers into the channel as ethical because then people's needs can best be determined and satisfied, conferring upon them the power of self-determination through choice.

But this choice is an illusion. For in our pursuit of a near-utopian promise of perfect health, we have, without realizing it, given corporate marketers free reign to take control of the true instruments of our freedom: objectivity in science, ethics and fairness in health care, and the privilege to endow medicine with the autonomy to fulfill its oath to work for the benefit of the sick.

Their recommendation? Ban DTCA!

The prohibition of DTCA is consistent with regulatory aims to protect health and encourage appropriate medicine use. Unbranded disease-awareness campaigns for the condition a manufacturer's drug aims to treat are a form of DTCA. If these adverts are allowed under laws guaranteeing commercial freedom of expression, a regulatory rationale remains to (1) de-link them from suggestions to "ask your doctor" for a treatment and (2) to insist on prescreening of adverts by a government agency to ensure conformity with the law before they are broadcast or printed. Similarly, drug company funding of media promotions aiming to stimulate sales should be subject to the same regulatory control as direct advertising.
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A key question is whether there is sufficient political will among government regulatory agencies to better enforce existing regulations governing drug promotion or to introduce new solutions. Most regulatory agencies fail to treat regulation of drug promotion as a public health concern. Unless this changes, the public can expect more unfettered disease mongering warning them that without the latest treatment, life will be grim indeed.

Finally, does anyone believe this is a new problem? Should we have seen this coming when Clin-ton legalized DTCA? Probably, and I love the quote they find to show how people used to feel about the pushing of drugs 112 years ago.

Henry James's psychologist brother, William James, was so exasperated by "the medical advertisement abomination" that in 1894 he declared that "the authors of these advertisements should be treated as public enemies and have no mercy shown"

Great stuff from PLoS as always. How much do you want to bet that the US media is too thoroughly owned by these companies and their ad revenue to even cover that a major scientific journal has extensively exposed the harm of DTCA? This will have to remain a Give Up Blog exclusive, at least in this fricking country.