DTCA and <<(b)you don't like planetRX>
Let me elaborate some more on a huge battle which is taking place behind the scenes in the medical profession.
In the beginning, medical insurance companies actually used to respect doctors by calling them "doctor". They performed actuarial services and spread out the risks of the costs of catastrophic illness over many people. Doctors prescribed medications.
Lately, medical insurance companies no longer call doctors "doctor". They call us "providers". They have moved far beyond the role of insurer into the role of medical manager. Drug companies have confiscated prescribing authority from physicians. Legally, we are the only ones who can sign the prescription pad. But the PBM closed formulary system has declined to reimburse the costs of often over half the FDA-approved drugs. In reality, we can no longer prescribe many drugs because the patients can't afford to pay for them above and beyond the cost of the medical insurance which they have earned. [As an aside, whenever an HMO manager calls me "provider", I usually respond by referring to them as "excretor"--they excrete carbon dioxide when they exhale and excrement when they defecate. Of course it would be better if both parties treated the other with respect and with their preferred title, but what goes around comes around]
Legalizing Direct To Consumer Advertising (DTCA) was an incredibly irresponsible thing for the FTC to do. It might seem politically correct to empower consumers with information about prescription drugs. But it takes four years of medical school and then at least a three year apprenticeship to begin to know how to balance pathophysiology, epidemiology, adverse effects, efficacy, cost and cost-effectiveness in prescribing decisions. Also the collective fund of medical knowledge is exploding. DTCA implies that patients suddenly deserve an opinion in what medication is prescribed. And it implies that a doctor is not doing right by his or her patients if he does not value the patients request for a stupid drug like Rezulin. Now doctors are forced to waste their already-increasingly-limited time reassuring patients that they are getting first-rate care with some other drug besides Rezulin.
It has been utterly amazing to have some patients who work for Monsanto come to me and tell me that they have worked on Celebrex, that they know all it, and they want to try it (like it is trying a new brand of perfume). None of them have even heard of Meloxicam. They were completely ignorant of its great promise and fanfare and then the realization that no matter what the theory predicted, it really was no better than some conventional NSAIDs in terms of side effects when larger studies and longer followup periods were completed. All they see is ads with balloons and confetti.
Anyway, Here is a link to an article about the abuses of DTCA.
medicomint.com
And here is part of a New York Times article about promises of free college scholarships to schizophrenic patients who take a drug company's new product.
Mental Health Drugs Now Marketed Directly to Patients
By MILT FREUDENHEIM
Tuesday, February 17, 1998 Copyright 1998 The New York Times
Using tactics that would have been unthinkable a few years ago, the pharmaceutical industry is increasingly marketing mental health drugs directly to consumers. In a break with past practice, which was simply to advertise in medical magazines and buttonhole doctors, manufacturers of antidepressants began advertising in general-interest magazines for the first time last year. And several companies have promoted psychotherapeutic drugs to mental health patients and their families through the Internet and sophisticated direct mailings.
The marketing of mental health drugs to consumers, which surged last year, added to the explosive growth of direct-to-consumer advertising of many types of prescription drugs. Drug companies say the advertising and other marketing tactics provide information that helps patients overcome their problems. Spokesmen for the industry add that patients are protected because only a doctor can write a prescription.
But critics say patients who are influenced by the marketing programs may seek out doctors who might be willing to prescribe drugs that are not right for them. Some doctors and patient advocates say that people with certain mental illnesses are much more susceptible to being manipulated than those with other medical problems. "People who are seriously mentally ill often have impaired judgment," said Dr. Sidney Wolfe, executive director of the Health Research Group of Public Citizen, a consumer advocacy group in Washington. And while the problems of ill-advised self-medication and invasion of privacy may apply to any patient taking medication, doctors say that the mentally ill are especially vulnerable. "There continues to be a clear stigma against the mentally ill in America," said Dr. Harold Eist, a former president of the American Psychiatric Association.
In the most aggressive example of approaching patients directly, Eli Lilly & Co. said recently that it would offer scholarships to some schizophrenic patients who took Zyprexa, its new antipsychotic drug. The scholarships, Lilly said, would help people with schizophrenia prepare for normal lives by taking college or professional school classes. But critics said the marketing pitch could encourage patients to risk the ill effects that can follow the switch in medication and could raise unrealistic expectations, because few people with schizophrenia can cope with higher education.
In a second approach, a number of drug companies are finding new ways to collect the names of people with mental health problems, as well as other information about them -- data that can be used for marketing purposes. Janssen Pharmaceutica, for example, urges visitors to its Internet site to register for updates on psychiatry and schizophrenia "relevant to your personal interests." In a related program, Janssen, a unit of Johnson & Johnson, urged users of Risperdal, its schizophrenia drug, to call a toll-free number to join a "person to person" program that includes reminder calls to take the Janssen medicine. Spokesmen for the companies said the aim was to provide patients with information that they could then discuss with their doctors. But critics said that a drug company could follow up on the initial contact with personalized letters to patients. Such letters could suggest that they demand a particular drug from their doctors, whether or not it was appropriate.
In sum, in my opinion, there is a big struggle which attempts to redefine who a physician is and what he can do. Physicians are legally banned from collective bargaining, so they have no chance when they negotiate contracts with giants like Aetna. The stories of doctors unionizing are going to become more common. Clearly physicians abused their authority in the past when they were treated like kings, but the pendulum has swung too far in the opposite direction, and the problem seems to worsen with each year.
Best Regards,
Tom |
