Whats wrong with DTCA
Here is a link to a fine article which interviews Andrew Balas, M.D. Ph.D. Dr. Balas was the lead author of a seminal article in the Journal of the AMA (JAMA) which studied the quality (methodology) of studies on cost-effectiveness of clinical interventions, such as drug therapies.
<<Politely but firmly, the article contended that a great many of the cost-effectiveness calculations presented in clinical studies over the past few years have been just so much hooey.>>
managedcaremag.com
Here is the actual reference to the JAMA article...
JAMA Volume 279(1) January 7, 1998 pp 54-57
Interpreting Cost Analyses of Clinical Interventions
Balas, E. Andrew, MD, PhD; Kretschmer, Rainer A. C., MD; Gnann, Wolfgang, MBS; West, David A., PhD; Boren, Suzanne Austin, MHA; Centor, Robert M.,MD; Nerlich, Michael, MD; Gupta, Mahendra, PhD; West, Timothy D., PhD; Soderstrom, Naomi S., PhD
From the Schools of Medicine (Dr Balas and Ms Boren) and Business and Public Administration (Dr West), University of Missouri, Columbia; School of Medicine, University of Regensburg, Germany (Drs Kretschmer and Nerlich and Mr Gnann); School of Medicine, University of Alabama, Tuscaloosa (Dr Centor); School of Business, Washington University, St Louis, Mo (Dr Gupta); College of Business, Iowa State University, Ames (Dr West); and School of Business, University of Washington, Seattle (Dr Soderstrom).
Whats the point?
Well if, as of January 1998, the 97 relevant articles published in medical journals which have attempted to inform doctors about how to calcualte the cost-effectiveness of drugs (and other interventions) are a bunch of hooey, it follows that it is extremely difficult for concernced, committed physicians to make correct decisions about which drugs are most appropriate. In general, at the moment of prescribing, physicians are often poorly-informed about many aspects of their prescribing decisions.
Then how in the world can a nonphysician, who has not made it their life's work to do this kind of stuff, have a meaningful opinion about which medication is most appropriate?
DTCA is an outrageous scam. Big Pharma plays on the arrogance and ignorance of patients with the following subliminal message: "You are not a patient--You are a CONSUMER!" "Flex your newly-awarded muscles of consumerism to tell that doctor what you need" The ads say "ask your doctor about..." but the psychology, the music (when it is TV), and the emotional guidance promise HAPPINESS from a pill bottle. Consumers don't ask for happiness, they demand it. And if doctors don't give the consumers what they want, the doctor has to waste precious, limited time repairing the damage to the physician-patient relationship.
The following link discusses this problem and describes some insurance companies which are refusing to pay for DTCA drugs (they exclude them from their formulary lists of covered drugs).
medicomint.com
It is true that constitutional rights to free speech prevent the government from banning DTCA. In fact, yesterday, the U.S. Supreme Court just struck down the FDA's attempts to regulate some of the labeling claims on health foods.
news.excite.com
But the gullible public is no match for the sophistication and deep pockets of Big Pharma-sponsored advertising. Schering Plough spent $190 million advertising Claritin in 1998--its sales exceed $1 Billion annually, and, oh by the way, it is no more effective than placebo in several recent studies. [In fairness I should mention that older studies did show Claritin to be more effectiv than placebo--but the 60 randomized controlled human studies published about Claritin are an intriguing and highly complicated topic--the perfect subject for a DTC ad]
It says a lot about DTCA when the public clamors to buy alternative medications, which have not been proven safe and which have not been proven effective (basically because the millions of dollars that should be spent paying for research on them are taken as profits by these drug manufacturers instead of R&D expenses).
So along comes PlanetRx to announce that they are going to take the easy money from Big Pharma and integrate DTCA into their online pharmacy, and Rezulin will be their paradigm. And they are going beyond simple Rezulin ads, to actually sponsor the diabetes discussion group on PlanetRx, so they can influence people who may let their defenses down and not even realize that they are receiving advertising.
This is why I don't like PlanetRx. They sold out and chose the easy money. They may become popular with patients, but it will be interesting to see if the people who are responsible for ensuring that the public receives value for health care spending (physicians, managed care organizations, payers--i.e. employers) will take any actions to discourage people from going to that site, or more likely will encourage people to go to uncontaminated online pharmacies.
Tom D |
