Are drug ads undermining attempts at 'thrifty' healthcare behavior? 8 thoughts

Critics have railed against direct-to-consumer ads for prescription drugs since the 1990s. Opponents of the ads, many of whom are medical providers, say they contribute to unnecessary anxiety and self-diagnosis among patients, inflate demand for expensive brand name drugs that may be medically unnecessary and contribute to a culture of over-utilization.

Supporters, on the other hand, say the ads help cultivate a new class of informed healthcare consumers who use information from the ads to initiate meaningful conversations with their physicians. Money earned by drugmakers as a result of increased sales due to DTC ads also helps support the research and development required to produce new important drug therapies.

The debate surrounding DTC drug ads is contentious and has captured increased attention this election season as both the Democratic and Republican nominees discuss the need to control the rising cost of prescription drugs. 

Here are eight thoughts from both sides over the debate on DTC ads for prescription drugs.

1. The U.S. is one of just two countries that allow pharmaceutical companies to market drugs directly to consumers, the other being New Zealand. In other nations, drugmakers market their products to physicians. The FDA first legalized DTC drug ads in 1985, but they only really became prevalent in 1997 when the FDA scaled back requirements on the level of detail drug companies had to provide about side effects, according to the World Health Organization.

2. Since the late nineties, prescription drug advertising has become a multibillion dollar industry. In the last four years alone, prescription drug ad spending soared by more than 60 percent to reach $5.2 billion in 2015, according to STAT. This is a marked increase from the year prior, when the industry spent $4.5 billion on DTC ads, market research firm Kantar Media found. 

3. Many healthcare professionals and associations say the ads are detrimental. They argue DTC ads fuel demand for expensive brand name drugs among consumers, leading to a significant rise in national drug spending. In 1999, the American Medical Association issued a statement that said, "Physicians must remain vigilant to assure that direct-to-consumer advertising does not promote false expectations."

As the drug marketing industry continues to grow, the AMA has taken a more aggressive stance. Last November, the AMA called to ban DTC ads outright, arguing the proliferation of the ads "drives demand for expensive treatments despite the clinical effectiveness of less costly alternatives." They say the potential influence of DTC ads on consumer behavior contradicts the broader goal of the ACA to develop thriftier healthcare shoppers and reduce utilization of unnecessary medical services and drugs.

4. DTC ads can influence physicians' prescribing practices. According to an October 2015 poll from Kaiser Family Foundation, 28 percent of the public reported asking a physician about a drug they saw advertised and 12 percent said their physician prescribed it. While sometimes these conversations result in a prescription aligned with an evidence-based treatment plan, in other cases physicians might feel pressure to provide the desired medication when it is not medically necessary to avoid straining their relationship with a patient.

5. Critics also argue the high cost of brand name drugs is at least partially influenced by demand, which DTC ads contribute to. While the ads may influence patients to ask for drugs after seeing advertisements, the high cost of prescription drugs is also a top health concern among the American public, according to the same poll from Kaiser Family Foundation. These concerns are warranted — prices for both generic and brand name drugs have risen steadily over the past few years. In 2015, total drug prices experienced a 4.7 percent hike, according to the Altarum Institute for Sustainable Health Spending.

6. Supporters of DTC ads for prescription drugs argue the ads are educational. Proponents say the ads align with the push to arm consumers with information, as medication is an integral part of healthcare and consumers should know their options. TV ads, like the internet, open the door to new opportunities to obtain information, whereas in the past patients were limited to the information their physicians gave them during visits.

7. Physicians who prescribe drugs to appease a patient against his or her better judgment must improve their communication skills. "The physician is still the one in charge, regardless of the information out in the public space," says Debbie Landers, senior vice president at Jarrard Phillips Cate & Hancock, a strategic communications and engagement firm for healthcare providers. "The physician is the one who ultimately decides whether or not to prescribe the medication." If the drug is not necessary, the physician must know how to politely but effectively convey why he or she will not prescribe it, according to Ms. Landers.

8. DTC drug ads are not going away any time soon. Advertisements for prescription drugs are unavoidable, and their influence may be equally so. While the predominant sentiment among providers regarding DTC ads is negative, the reality is marketing for prescription drugs is proliferating in other mediums, such as the internet and social media. So as the AMA and other organizations wage their fight against DTC ads, providers will benefit from preparing to talk to patients about the medications they showcase.

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