At The Health Care Blog, Maggie Mahar points out a disturbing reason why drugs companies hit the airwaves — because docs aren't responding to the direct pressure.
In other words drugmakers are going directly to the consumer at a time when their products are, indeed “at the margins of evidence-based medicine.” Experience with drugs like Vioxx has taught many doctors to take a wait-and-see attitude toward remedies that have not yet been widely used by the general population. Unless the “new, new thing” is likely to save lives, many prefer to wait until more evidence has come in about risks versus benefits before turning their patients into guinea pigs.
Meanwhile, the NEJM reports, drugmakers have stepped up their campaign to market their wares to laymen. From 1996 to 2005 spending on DTC promotions has grown more than three-fold, spiraling from $985 million to $4.237 billion.
And the crazy part is, of course, it works. (Much of the direct-to-doc sales pitch works, too — let there be no mistake.)
Hrm … health care premiums just jumped by double digits in MA … again. Drug costs may or may not be the major drivers behind the increase, but surely, any responsible cost-control effort has to address pharma marketing. Health Care For All has some ideas in its cost control agenda (pdf), but most of these measures target marketing direct to docs. The problem may well be the consumers who want magic pretty pills — even if they're snake oil.
And more generally … Hey legislators: It's either continued fiscal ruin for the Commonwealth's cities and towns; more property tax increases and bitter Prop 2 1/2 battles; and a new health care law blowing up (again); or, you can deal with costs, boldly and decisively. Choose.
…because docs aren’t responding to the direct pressure.
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I would have thought that the docs would respond to direct pressure from the phamraceutical companies, largely because the pharma companies give them so many perks. I guess at least some docs in the US are resisting that.
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A few obsrvations
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Regarding the statement in the blockquote Unless the “new, new thing” is likely to save lives… I’d put it somewhat differently. The way I would put it is something along the lines of the following: unless the new, new thing is shown to be significantly more effective than an older (out of patent, and hence, generic) thing, it isn’t worth the risk of adverse effects to prescribe the new, new thing. Aside from the increased cost of the in-patent proprietary drugs, there is the possibility of adverse effects from the new, new things. The sad fact is that, given the lax supervision of the FDA, recently licensed pharmaceuticals are really merely in beta test. Much like software. And will be in beta test for many years. Unless you are allergic to them, the only miracle drugs are Aspirin and penicillan, and, if you are allergic to them, there are more than a few old substitutes.
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Regarding
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Hrm … health care premiums just jumped by double digits in MA … again. Drug costs may or may not be the major drivers behind the increase,
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apparently, not all health care plans cover pharmaceuticals, so I’m not sure how much pharma costs contribute to the increase. My BCBS plan certainly did not. When I went on my spouse’s GIC plan, it did cover pharma costs, but we have to pay extra for that coverage.
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A further observations: we don’t watch TV very often when we’re in the USofA, but when we have, we were struck by where the pharma ads were placed. Primarily in programs that would appeal to the elderly–news programs and such. Obviously, the pharma companies are doing that to try to get the elderly to mau-mau the doctors into prescribing the pills.
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As I’ve related here before, when my mother in law was living in the US, the doctors would habitually prescribe Valium for her. When she moved back to the US, her doctor said “no, you don’t need it.” Many pharmaceuticals can be quite addictive, and the German doctor’s response was what probably helped her along.
factors. I look at it as a 1 or 2 steps forward and 1 or 2 steps back dance in containing drug costs and access.
Thanks for the link to HCforAll. I am at work now so I cant read that or leave much of a comment today–just a quick note to come back to look at this later.
So far, as maddening as it is, Mass Health I believe does a decent job with their drug review system. I am generally comfortable with Mass Health's formulary management.
On the fed level Medicare part D was a big step back for costs. Medicare is, as we know, prohibited from negotiating drug costs. Insurers do negotiate their forularies–but with so many companies involved it can be really time consuming for pharmacies and providers to keep it straight. My subjective experience is that the beaurocracy of far-flung big insurance companies is much harder to deal with than Mass Health.
Concerns about marketing to providers and patients (I hate the word consumer) is something that gets deserved attention. I bet big Pharma marketing to insurance companies plays a big role in driving costs too.