By John Kamp • Executive Director of the Coalition for Healthcare Communication
The debate in Washington over drug pricing is getting louder and nastier, and drug marketing is getting caught in the crossfire.
Although it may be convenient to blame this smear campaign on political rhetoric in the heat of early presidential campaigning, polls are showing that while Republicans and Democrats spar over Obamacare, the American people are focused more on drug price. Little wonder that both Hillary Clinton and Bernie Sanders proudly include drug companies among their “favorite enemies” and that their Republican counterparts are joining the conversation.
The role of drug marketing, particularly DTC broadcast ads, as a factor in drug utilization and pricing is also a part of the public’s concern. Not overlooked by the politicians, but largely ignored by the press, is a major Kaiser poll which found in October that about half of the public thinks that drug advertising is mostly a good thing, while nearly 40 percent say the opposite. The same study found that about 60 percent of the public believes that drug companies spend too much on marketing to patients and doctors. The Kaiser findings on the effects of drug advertising are more complicated. About 30 percent say they have talked to a doctor after seeing or hearing Rx drug ads. Of those, roughly 15 percent were recommended to make changes in their life style, about 14 percent were recommended a different drug, 12 percent were given the prescription they asked for, and 11 percent were recommended an over-the-counter drug. Indeed, these results suggest to me that although DTC works somewhat to increase scripts, it more often works to generate other medical interventions.
From my perspective, that’s a public policy advantage for DTC, not a disadvantage. But, as a recent American Medical Association (AMA) House of Delegates vote demonstrates, not all doctors agree.
In a surprising move, the AMA announced recently that it would support a ban on DTC advertising in an effort to make prescription drugs more affordable and address member concerns regarding “the negative impact of commercially-driven promotions and the role that marketing costs play in fueling escalating drug prices.” The measure was passed Nov. 16 at the group’s 2015 Interim Meeting in Atlanta.
The AMA call for a ban on DTC advertising is a policy mistake and flies in the face of the First Amendment. Most importantly, patients and caregivers want and deserve up-to-date information on the availability of drugs. The days of Dr. Kildare being the exclusive source of information about health and medicine have come and gone. Beyond that, a ban on speech would violate the spirit and letter of the First Amendment right of companies to tell the truth about their products and services.
Meanwhile, mainstream economists disagree with the AMA on the role of advertising and prices, saying that while advertising expands the market for advertised drugs, it also has the effect of lowering prices.
Additionally, DTC advertising plays the following roles in the healthcare system:
• DTC ads help patients and caregivers recognize symptoms and possible solutions for health issues. Indeed, one of the AMA dissenters to the new policy pointed out the role of early antidepressant advertising to help patients recognize their difficulty and seek medical help.
• DTC advertising currently is the most aggressively regulated advertising available. This is clear from the careful and lengthy side effect disclosures in every broadcast ad. Eliminating these ads would keep consumers in the dark about both the benefits and the side effects of medicines.
• Numerous studies have demonstrated that patients who seek out information and have robust conversations with their doctors are more likely to adhere to directions and achieve better health results.
• The Pharmaceutical Research and Manufacturers of America (PhRMA) and its members closely follow a DTC advertising code of self-regulation that emphasizes full and fair-balanced information, as well as a delay in the commencement of consumer advertising until professionals have had an opportunity to learn about new drugs.
Make no mistake about it. The public and politicians are concerned about drug prices and uneasy about drug marketing. Respecting that reality, the Coalition for Healthcare Communication, the American Association of Advertising Agencies and The Advertising Coalition are working hard in policy circles to tell a more complete story and fend off further regulation. We don’t expect immediate action at FDA or in Congress, but it is clear that we have to communicate more assertively the bullet points raised above, as well as promote the facts that DTC advertising is not responsible for increases in drug pricing and has positive effects on patient care.