I want to return to those halcyon days without Halcyon, a time when the cheesiest commercial spots sold macaroni and makeup. Today I need a Physician's Desk Reference to understand the commercials, a medical degree to order them, and a fat wallet to buy medicines from the pill pushers paying for prime time.
Part of restructuring healthcare means addressing the two-tier drug system of high-cost "brand" and lower-cost "generic" medicines and the billions of dollars used to sell medicines.
Why advertise something that it takes a doctor's approval to obtain? Consumer Life reported:
"If you came into a physician's office with an ad for a drug you saw advertised," suggests Dr. Robert Seidman, chief pharmacy officer for WellPoint Health Networks, in Thousand Oaks, California..., "and the doctor says you don't need it, but you say I really want it, in most situations, the doctor's going to say OK let's try it barring no interaction with other drugs. And that's because physicians are very busy and it's very difficult to fight Madison Avenue."
Drug companies spent more than $4.4 Billion in 2008, according to Commercial Alert, on ads targeted directly to consumers. That is up from $4 Billion back in 2005, according to the Chicago Tribune. Still, that is a drop in the bucket of their total marketing to physicians. Drug companies spent $29.9 billion in 2005, compared to $11.4 billion to promote products in 1996 .
The drug companies have taken the public relations line that increased prices in drugs are due to more R&D. Right now, almost twice as much is spent on drug promotion in the US as is spent on R&D. Science Daily reported on a study done by two York University researchers in January of 2008:
The researchers' estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.
WEBMD reported that the New England Journal of Medicine conducted a study of drug advertising in 2007.
They compared drug companies' 1996 and 2005 spending for direct-to-consumer drug ads shown on TV and web sites, played on radio stations, and placed in magazines and newspapers.The study shows that in 2005, drug companies spent 330% more on direct-to-consumer drug ads than in 2006.
Some will point out that these ads bring awareness to the symptoms of diseases that average Americans watching TV might otherwise not know about. Others observe that these ads undermine doctors and often misinform.
Bio-Medicine reported in 2001:
An increase in the number of advertisements by the drug companies has prompted the doctors to urge the government to ban prescription drug ads from television, news papers and magazines. American Medical Association's New Jersey delegate Dr. Angelo agro said that such ads can undermine doctor's credibility especially if physician thinks an advertised drug isn't the best choice for a patient who demands it. He also added that ads have tuned into a competition "to see who can sell more of their anthistamines of nasal sprays. The patient is at best incompletely informed and at worst deluded."
Blockbuster medications are often more hype than fact. The "purple pill" Nexium is a very close cousin of AstraZenica's now generically-challenged Prilosec. In side-by-side tests of people whose acid reflux disease is eroding their esophagus, Nexium healed the damage about ten percent better, 97% to Prilosec's 87%. The limited subset of patients who benefit from this is small relative to the acid reflux population, which is also limited. Yet the New Yorker reported in 2004:
Nexium hit the pharmacy shelves priced at a hundred and twenty dollars for a month's worth of pills. To keep cheaper generics at bay, and persuade patients and doctors to think of Nexium as state of the art, AstraZeneca spent half a billion dollars in marketing and advertising in the year following the launch. It is now one of the half-dozen top-selling drugs in America.
Clearly some people really benefit from the medication, but how many others are spending thousands of dollars for a medicine that they do not really need when its cousin, Prilosec, or a much cheaper generic now available, would work as well?
Patients who can buy a generic often do not, either because they are sold on an ad, afraid that there is something inferior about the generic, or the doctor pushes the brand name drug.
When I was told that I needed a cholesterol-reducing drug, my doctor put me on Crestor. I paid about $115.00/mo.for the brand version of the medicine as Blue Cross/Blue Shield of Florida only picks up a fraction of the cost of a "name" drug. I asked the doc to switch me to a generic statin drug. I get the same results for about $15 to as little as $5.85/mo. or about 87% to 95% less than the brand name product.
Even in the over-the-counter market, the disparity in cost between generics and hotly advertised drugs are staggering.
The allergy medication Zyrtec will cost you around $22.00-$28.00 for a 30 count bottle in most parts of the country, while a generic 60 count goes for about $14.99. One pharmacy offers 240 pills for 50.00. You can pay .73/pill for the brand drug, or as little as .21/pill for the generic.
What is the difference, other than the label, between a generic and the brand name drug?
To pass FDA muster, active ingredients are identical. If there are substitutions, they can only be inert or non-active ingredients like food coloring or a sugar-coating that do not change the value of the medicine.
The Obama Administration has been questioning the fundamental underpinnings of some of these systems that have evolved and mutated over the years. Our system of distributing medicines to an increasingly aging population of Baby Boomers has spiraled out of control.
Generics sprang up as a cheaper alternative to the high-dollar brand medications. The bigger question is: Why do we need both?
Pill prescribing should be the province of physicians, not big pharma. Medicines should stand on their efficacy to cure an illness, not on whether Bob is smiling after taking it, or the little guy in the hard hat and his team can spray the big bottle into the nose. Medicines that are still under patent need to be affordable, and medicines with competition need to be competitive, not seeking ways to eliminate or reduce competition.
Cutting the billions of dollars wasted on advertising these products can bring an immediate benefit to both the cost and the quality of health care. It is not as if Congress lacks the authority, or the mandate to twist television's arm.
Broadcasters who use the public airwaves already limit ads for tobacco or firearms, and restrict alcohol producers' ads. Banning prescription drug ads, or severely restricting them, would be beneficial to an already crumbling system of healthcare in this country.
In other countries, plenty of people take these medicines, but there is nary an ad, nor a television testimonial to be found. The medicines are also dramatically cheaper, in large part due to their reduced costs to promote and distribute.
If healthcare is going to take a turn for the better, physicians are going to have to retake control of the prescription process, and big pharma is going to have to quit peddling purple pills on TV.
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And it works. $10.4 billion in total advertising is a small price to pay to reap the $227.5 billion spent on prescription drugs in 2007. Comparing the cost of the raw ingredients vs. the retail cost to consumers, the markups on Paxil, Zoloft, Celebrex, Prozac, and Xanax are 2,898%, 11,821%, 21,712%, 224,973%, 569,958%, respectively. The pharmaceutical industry is the third most profitable industry in America, according to Fortune Magazine (trailing only communications and internet industries for return-on-investment), with 2008 profits of 19.3% of revenues. The profits of the three largest pharmaceutical companies were $12.9, $8.1, and $4.8 billion in 2008, respectively.
“Surveys reported in our medical literature reveal that when a patient comes into a doctor’s office and requests a specific drug that he has seen advertised in the media, the doctor writes the exact prescription the patient requested more than 70 percent of the time!â€
So, let’s say that a consumer who has been feeling a little sad lately sees a commercial for the antidepressant drug Zoloft. The commercial demonstrates the symptoms for depression and the consumer identifies with them. Suddenly, he or she thinks, “I’m not just sad. I’m depressed, which is a ‘medical condition that can be treated by the prescription drug Zoloft.’†With this in mind, the consumer goes to a medical doctor and says, “I’ve been really depressed a lot lately. I’ve been [the consumer recites the depression symptoms listed in the Zoloft commercial]. I think I need Zoloft.†So, according to Strand, there’s a 70 percent chance the doctor will prescribe Zoloft, the exact prescription the consumer requested. That’s how pharmaceutical commercials really work. They directly influence consumer behavior, yet drug companies claim they only “educate†patients, but don’t persuade them to do anything.
Why do we need both generics and the original drugs developed by brand name companies?
We’re glad you asked: Without brand name drugs, there are no generics. If there were already drugs to cure every disease and it was clear no new illness would ever erupt, we could stop our daily search for new treatments and cures. But in fact, millions of Americans live in the hope of new drugs.
America’s pharmaceutical research and biotechnology companies work to fill that need, and in 2007 invested $63.2 billion on R&D. During that same year, they spent $11.5 billion on promotional activity directed to physicians, journal advertising and consumer advertising, according to IMS. Last year, despite unfolding economic challenges, a record $65.2 billion was invested in R&D. Biopharmaceutical companies comprise “one of the most research-intensive industries in the United States,†according to the Congressional Budget Office (CBO). These firms invest as much as five times more in research and development, relative to their sales, than the average U.S. manufacturing firm, CBO states.
We agree that prescribing decisions are best made by physicians, who can determine the optimum treatment for their patients. We don’t agree that physicians are unduly pressured to prescribe medicines their patients see advertised. Note, first off, that 14 of the 15 most commonly prescribed drugs,and 72% of all prescriptions, were filled with a generic in 2008.
This article touches on lots of important issues in healthcare today: generic vs. brand-name meds (with respect to quality and insurance coverage), medicine for profit or not-for-profit, drug company financing for advertising relative to R & D, the development of "new" drugs which are really new versions of old drugs which have gone off-patent (generic), etc. Several years ago, I took a terrific seminar on Healthcare Policy at the University of Vermont (http://learn.uvm.edu/hm/) where I am a student in the post-bac pre-med program. We covered a lot of these topics over the course of the semester, and I would encourage anyone interested in these issues to check it out.