The TV ads you see for drugs add up to $6 billion, which is a small fraction compared to industry R&D.
Incidentally, I have had two occasions where I wanted to search for a product by its physical dimensions. One was for furniture and one was for a refrigerator. I haven’t seen a search engine that lets me start by searching by physical dimensions: length, width, height. On these occasions, I had a specific physical space that I needed to put something into.
The rest of the world manages to 'discover' that these drugs exist on the market just fine, yet pharma advertising is banned in most of it.
Just like the FDA reviews drugs for safety and efficacy, and just like your insurer reviews drugs for price, national health boards review drugs for safety, efficacy, and price.
Sometimes, the boards want to wait and see if the drug is actually effective in clinical use.
Sometimes the boards want to wait and see if the drug is actually safe in clinical use.
Sometimes, that equation does not swing in the drug's favour. If a drug is $10,000/year, compared to a $500/year, but provides someone taking it for 10 years, on average, with a month's extra life, it would be foolish to spend $100,000 on the better drug - if for that money, you can buy more than a month of life for other people, with another drug, or with surgeries, or better screenings, etc, etc.
Likewise, if a drug improves quality of life for someone, how do weigh that against saving someone's life? There's a limited medical budget, and there's some ethical calculus that you plug the numbers in, and determine which of those options is a better use of scarce resources. But in order to do that, you actually need to get the numbers. Clinical trials, in themselves, don't give all of those answers.
The FDA differs from the FAA, in that the world does not consider it the sole gatekeeper of medical efficacy, safety, and cost.
What will not solve this problem, is the drug manufacturer spending half a billion dollars on taking doctors, medical directors, and politicians on all-expense paid junkets to the Carribean. You're not going to get better awareness from this, you're going to get more corruption, and more expensive drugs. (The $500/year alternative can't compete with the $100,000/year alternative in this sense - as the manufacturer of the latter can trivially out-bribe the former.)
This drug costs more than $10,000 per year because it is an orphan drug. There's little to no money spent on marketing for this drug. None that I've ever seen and I'm the target market for it. The net margins for the pharmaceutical company that manufacturers the drug is now around 20-25%, but their net margin was very very deep in the red for the first ~6 years that I took the drug. Not sure if they have yet recouped the investment from the 7+ years that they were in the red.
> it would be foolish to spend $100,000 on the better drug - if for that money, you can buy more than a month of life for other people, with another drug, or with surgeries, or better screenings, etc, etc.
It's not foolish if you're the one whose life is bettered by the medicine in question. How my healthcare dollars are spent is my decision, not the government's decision. This is where the arguments for single payer healthcare break down because you're arguing to take away my choices that I've earned by being useful to society. You're not the one paying the price for putting the decision in the hands of a bureaucrat. I and people like me are paying that price.
If it's an orphan drug, treating a rare condition, the economics of it are by nature difficult, because of the high fixed costs, and the low maximum revenues.
Since international medicine does not follow the same model as international aviation, it's not surprising that the high fixed costs (In time, research, and money) of adopting a new medicine + low, variable returns (Most countries are much smaller, or much poorer than the US), it's not surprising that the world isn't jumping on this head-over-heels.
Do you need this drug to live? If not, is it a marginal or significant quality of life improvement? If one of the latter, its possible that the cost/benefit analysis for it isn't great, and its manufacturer hasn't even bothered to go through the approval processes for other countries.
> It's not foolish if you're the one whose life is bettered by the medicine in question. How my healthcare dollars are spent is my decision, not the government's decision.
I'd like to decide how my military, policing, and grade school education dollars get spent, too, but there turn out to be exceptionally good reasons for why they should be spent collectively.
> You're not the one paying the price for putting the decision in the hands of a bureaucrat. I and people like me are paying that price.
Everyone will at some point need healthcare, so yes, I do pay the price, and I'd like a system that does its best to get good results for money spent.
And if your insurance is paying for this drug, keep in mind that some unelected insurance-company bureaucrat has done a cost-benefit analysis on it, and decided that they were going to pay it. They could have gone the other way with it, and decided that it was not covered by insurance. As someone who buys into health insurance, but does not consume much healthcare, I can use your same argument to argue that my hard-earned insurance money should be spent on me, not you.
If I asked my GP for a specific medication they'd look at me like an alien.
Doctors are mortals too and can only have so much time to draw on info they crammed X years ago. Patients can quickly become more expert than GPs with regards to their own diseases, especially if they have months to research it.
Anecdotal example - my sister had a wierd skin condition in high school. My mom researched skin images and symptoms for hours and hours and concluded it was shingles. My Mom then brought her in and discussed her findings with the GP who scoffed and said she was far too young for it to be shingles. He then admonished my mom for doing her own research. Long story short and one embarrassed GP later, it was shingles.
Other highlights of the surveys include:
Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.
Many physicians thought that DTC ads made their patients more involved in their health care.
https://www.fda.gov/drugs/drug-information-consumers/impact-...
Secondly, I see too many damn branded pens in my doctor’s office to be under the illusion that the marketing is only directed at the patients. I can’t count the number of times I’ve been prescribed medication just to have it swapped out at the pharmacy for a generic variety. Doctors are just as susceptible to advertising than the rest of us, except exclusively at harm to the patient.
The demonstrated “value” being provided seems to be mostly in the form of cash in the pockets of providers and pharmaceuticals, not in material benefit to the patients.
I can assure you that drug reps didn't bring in catered lunch to my ex-wife's GP office for the benefit of better informing patients about their choices. We got divorced 30 years ago, but I'd bet money I've still got a sticky note pad lying around the house somewhere with a pharma company's name on it.
There's plenty of drug marketing going on that will never come under the gaze of a patient.
They can be sued for making false claims. There's no value in doing so, especially in a high profile medication.
Why would you spend a couple billion dollars on research/marketing, years of research, to bring something to market only to shoot yourself in the foot by making false claims?
And a lot of us end up ordering our meds from gray-market online pharmacies anyway and paying for our own blood tests (usually via Private MD Labs).
One friend moved to become a patient of the #2 Lyme disease specialist.
Another moved to become enrolled in a clinical trial. He was proclaimed terminal and went doctor shopping. (Still alive today.)
I've stayed anchored in my house for decades because I won't risk leaving my care providers (SCCA, FHCRC). I've had terrible experiences with noob doctors. As in life threatening.
I now better understand how doctors think. Recurring rounds of 20 questions time boxed to 15 minutes. Hopefully they've seen your condition before. If not, oops, too bad, out of time, take two aspirin and call me in the morning. Next!
YMMV.
FWIW, it took a few years but I finally found a doctor I'm happy with. But I'm also lucky enough to live in a major US city.
Waking into a 15 minute appointment with months worth of research seems like a bad way to approach collaboration with healthcare professionals. Or do people still have personal relationships with doctors outside the appointment window?
It seems like GPs have become dispensers of medicine rather than care.
However, many people will at least do several hours of research before going into the doctor
So I have a friend with Hashimoto's. Before finally being diagnosed, she had a long history of being misdiagnosed, blown off, and having her symptoms dismissed as nothing. After being diagnosed, she connected with a number of other Hashimoto's patients and sufferers of chronic illness in general and found out that pretty much everyone she's talked to has the same stories. Constant invalidation, ignoring of symptoms, doctors just plain not listening, until they finally find someone who actually knows their stuff.
A couple of years ago my GI specialist put me on a medicine that had just been approved that was designed for my type of gut issues. We spent a lot of time talking about what we hoped to see, and he spent a lot of time listening to what my experience actually was. This has continued ever since, and he always spends a lot of time listening, because I am one of his few patients that takes that medicine. This patient / doctor feedback loop is incredibly important!
First, doctors are expected and generally pursue continuing education. As much as the "golfing at an exotic locale during a medical conference" is a meme, many of those conference also educate doctors on new therapies.
Second, let's not pretend that the drug conpany reps don't get as damn close to bribery as possible to get their medications in front of doctors and in hospitals
Those ads are a small portion of pharma marketing budgets for prescription products. The vast majority goes to direct-to-doctor marketing.
Given that experience, I'd not be surprised if pharma spend a ton of money on direct-to-doctor marketing.
Pharma TV and billboard ads are the last place I'd seek such information though.
edit: i'm getting downvoted. in case you weren't aware the subways in NY are plastered with HIMS and Roman health ads.
https://www.vice.com/en_us/article/ne5ndb/erectile-dysfuncti...
Not sure which one is better or worse.
Direct-to-doctor marketing is legal almost everywhere else, and it's by far what pharmaceutical companies spend more money on.
He shouldn't. They're not all knowing super genius specialists who keep up with all the drugs and research.
A Doctor writes a script, and then a pharmacist (not on their own, but at the direction of an insurance company) suggests a change typically to benefit the insurer (for example changing a name brand to a generic or changing 30 days to 90 days so the patient doesn't get seen by the doctor again for 90 days for additional testing/monitoring). In the US the pharmacy/pharmacist can not change the script so they send the recommendation to the doctor for approval (and get paid a bonus from the insurer for sending the request), if the doctor approves the pharmacy gets a 2nd bonus, if the doctor does not make the change, there is a very good chance the insurer will drop the doctor from their network for not doing what the insurer asks to lower their costs through the pharmacy proxy.
In most states, the law explicitly requires the pharmacist to fill a prescription with a generic (if available) unless the doctor specifically writes "dispense as written". Not allows - requires.
The purpose of these laws is to protect patients - in the overwhelming majority of cases, the generic and brand name drugs are equivalent for patients, so patients save money by purchasing the generic medication even if the physician prescribed the drug using its more well-known name (the brand name).
Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs.
Its also why the insurers pay the pharmacists a bonus for these changes, if it was about costs to the patient, the bonuses (money back) would go to the patient.
I mean, no, patients don't lobby for them because patients don't really lobby en masse for healthcare policy in general, but patients definitely are the ones who benefit from them.
There are some cases where the relationship between insurers and patients is adversarial. This is not one of them.
See Medicare for All.
Well imagine your doctor gives you a Rx, you go to fill and the insurer tells the pharmacist to ask doctor to change it. If the doctor disagrees (for whatever reason) the insurer may drop your doctor from their network, then you will be stuck going to a doctor who does whatever the insurer asks.
If you feel there is no conflict there or that isn't adversarial that is fine...in my experience both patients who lose their doctor and the doctors themselves disagree.
And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment.
The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.
For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interference with the doctor's practice of medicine. The doctor should make the determination, because they have the relationship with the patient, they know if they are at risk or likely to adhere to the therapies better than an insurer making broad brush strokes based on the cost to insurers. You also skip over the part where doctors get dropped from the insurers network when they don't accept the insurers "recommendations."
>The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.
Sure, but that is not how it works in practice, the patients won't set up another appointment until they need another script, which is cheaper for the insurer and worse for the patient outcomes. Nevermind the Doctor being in the best position to determine which patients should be seen every 30 or 90 days, the shorter duration and 30 day appointments lead to higher percentages of drug adherence...which is a major issue in the US leading to about 1 million hospitalizations per year.
I'm reasonably cynical about lots of things, but I would be absolutely shocked if a pharmacist can give you 90days of pills when handed a 30day (no refills) prescription.
If the Doctor(s) refuse to make the requested change that data is tracked and eventually the insurer will drop the doctors from their network.
I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.
Yes, the patient could pick up the phone and schedule another appointment, or the doctor could call to try to schedule another appointment in the meantime. You are missing the point...in practice those appointments don't get rescheduled.
The Doctors and insurers know this, which is why the Doctor tries to do 30 day scripts for at risk patients so they can be closely monitored, and its why the insurer attempts to change 30 day therapies to 90 day because they know the patient won't schedule an appointment in the meantime and that saves the insurer money.
Anyway its clear you see nothing wrong with an insurer interfering with a doctor's practice of medicine...or the other part you keep glossing over that is the insurer dropping doctors from their networks (i.e. patients losing their doctor) when the doctors don't follow the insurers requests for changes to therapies.
Such a patient isn't going to correctly take their medication either, 30 days or not.
> the other part you keep glossing over that is the insurer dropping doctors from their networks
Yah, because that's not actually true.
Insurance companies do a lot of bad stuff, but you seem to have invented a whole new class of things that they just don't do.
There is no bonus for 30 day to 90 conversion. There is only a lower co-pay for the member.
Exactly that is why the doctor specifically writes a 30 day so they come back in and can check their numbers.
>Insurance companies do a lot of bad stuff, but you seem to have invented a whole new class of things that they just don't do.
When you hear the term consolidation of the healthcare market this is what they are talking about. There are numerous lawsuits right now by doctors against insurers for dropping them, illegally, from their networks and sending their patients to new providers/practices that are owned by the insurers. You can find any number of those lawsuits, if you cared, but here is an article on the practice of insurers buying providers (to control all aspects of their costs), you have insurance A, odds are you are only able to go to a doctor practice/hospital owned by the insurer.
https://www.modernhealthcare.com/article/20180602/NEWS/18060...
>There is no bonus for 30 day to 90 conversion
You are wrong, and it is clear you have never even heard of Medication Therapy Management (MTM) or OutcomesMTM. Walk into any big pharmacy (walmart, cvs, walgreens) and ask the pharmacist about OutcomesMTM and MTM generally. Or use this link to a OutcomesMTM report and learn about it http://www.outcomesmtm.com/wp-content/uploads/2018/02/2016MT...
>"Today, more than half of U.S. pharmacies are active in OutcomesMTM programs, earning revenue for their clinical services while helping healthcare payors reach their goals."
>Each year, OutcomesMTM recognizes pharmacies and pharmacy chain organizations with exceptional performance in delivering MTM services. Top MTM Center and Top Chain awards are based on the organization’s overall effectiveness in delivering CMRs and resolving drug therapy problems through TIPs
If I go to my doctor and say "hey, for my condition XYZ I hear there's a new drug ABC, would that offer any benefits over what I'm on now?" that's one thing, but if I go in and say "hey give me that ABC" they'll correctly roll their eyes at me.
I get it, they're nearly always overworked and tired, and most of their clients are idiots.
But people should be free to try something new without all this gatekeeping that keeps getting worse.
At the same time, place the responsibility on the user if they request something out of the ordinary, of course.
I think it may be a win-win if the U.S. prohibited television medical advertising.
[1] https://economicdynamics.org/meetpapers/2011/paper_868.pdf
[1]https://truthinitiative.org/research-resources/tobacco-indus...
[1] https://www.drugs.com/sfx/orlistat-side-effects.html
[2] https://time.com/4317182/abilify-aristada-aripiprazole-sex-g...
[3] https://www.health.com/condition/depression/medications-depr...
i really believe pharma advertising should be banned