I have a confession. Well, not really a confession, because I’m not ashamed to admit it — and if you’ve been reading my Reality Health Check for a while you already know this about me. But here goes anyway …
I watch a lot of television. But my TV watching habits have changed drastically thanks to the DVR — much to the dismay of my friends in the advertising business, who pine for the good old days when they had truly captive audiences for their commercials. These days I can honestly say that I can’t remember the last time I saw a commercial.
It’s not that way for everyone, though, and here’s how I know: When patients ask their doctors for a specific medication, you can bet on the fact that they learned about it on TV.
That’s troubling in itself, but here’s where it gets truly disturbing. According to a recent systematic review of psychiatrists and their patients, the majority of patient requests for medications are granted.
That means it’s not really the psychiatrists using their best judgment about what (if any) medications a patient needs. It’s the advertisers with their million-dollar budgets sitting around a board room and designing a glossy campaign to convince patients of what they need. And then the patients — and their docs — buy it, hook, line, and sinker.
Does that sound deceitful to you? Yeah, me too.
And here’s why. The conditions being treated by psychiatric drugs are highly prevalent, and they can cause their sufferers immeasurable distress. So using direct-to-consumer advertising (DTCA) to play on the emotional soft spots people are experiencing to make a quick buck just feels … wrong.
Of course, they’re not just making a buck. They’re making billions of them. In fact, U.S. spending on retail prescription drugs for mental and substance abuse disorders is expected to top $400 billion in 2017.
Those million-dollar advertising budgets are starting to make a little more sense now, aren’t they? Let me tell you how they came about.
After the US Food and Drug Administration (FDA) relaxed its guidelines for marketing pharmaceuticals in 1997, DTCA expenditures skyrocketed. Spending on DTCA grew from less than $800 million in 1996 to $2.5 billion in 2000, eventually peaking at $4.9 billion in 2007.
Psychiatric medications are among the most heavily advertised drugs and were among the first to attain blockbuster status. Data from 2014 to 2015 indicate that psychiatric drugs represent 20 percent of the 10 most advertised drugs and 10 percent of the 100 top-selling drugs.
And of course all this advertising money has to come from somewhere, right? The drug makers bake it into the cost of the medications — which is yet another reason that prescription medication costs are skyrocketing.
Now can you guess who ends up paying for the inflated costs of prescription medications? If you guessed “all of us,” you’re right! Through higher insurance premiums, higher out-of-pocket deductibles, and higher copays, we are all footing the bill. Meanwhile, the government agencies charged with protecting us fall woefully short.
And here’s the worst part, in my opinion. These advertisements aren’t even true! They provide inaccurate and biased information that favors pharmaceutical companies and absolutely promotes unnecessary prescribing.
The truth is, these medications are fraught with problems. Take antidepressants, for example. Study after study shows they have only trivial benefits. And in many cases, those meager benefits do not justify the side effects they cause.
Not to mention the fact that depression is poorly diagnosed to begin with. In fact, most patients given antidepressants do not even meet the criteria for being depressed.
Could that be because they’re going to the doctor asking for the cure-everything pills they saw advertised and the doctor caved? The research sure points to that as a distinct possibility.
But would you believe there have been only four studies in the entire body of medical literature looking at the issue of DTCA medication prescriptions? I won’t bore you with the details, but I will summarize the results…which speak for themselves, loud and clear.
In three studies, 2.6 percent to 9 percent of patients requested DTCA medication. That’s between 1 in 11 and 1 in 42 patients goes to the doctor requesting a drug they learned about thanks to those massive advertising budgets.
And the fourth study really highlights the fact that the ads are to blame for these requests. It compares specific medication requests in an American clinic to those in a Canadian clinic. (Canada — wisely — bans direct-to-consumer advertising).
The findings? More than TWICE as many Americans requested medications. And here’s the kicker (but no surprise if you’ve been paying attention): The patients who asked for one or more DTCA drugs had significantly higher odds of walking out with a new prescription than patients who did not request DTCA drugs.
So clearly the patient does not hold all the blame for these requests. The doctor is the one pulling out the prescription pad and signing on the bottom line.
This is a vile situation in which we are squandering billions of dollars each year. That money could make an enormous difference in any number of necessary and vital healthcare functions. But it’s not. It’s going to advertising and television companies.
Here is the bottom line: DTCA is a technique to increase sales of lucrative drugs targeted at poorly diagnosed disorders, where there is ample opportunity for interpretation. And clearly the technique works. Doctors are not good enough at saying no, because saying yes is usually easier.
So my advice? If you don’t own a DVR and can’t fast forward or skip over the commercials during your favorite TV shows, use those few minutes to get up and move around — away from the TV and the influence of shady marketing that doesn’t have your best interests at heart.