Prescription drug update: prices (up), DTC (working), and generics ("the un-detail")
There is much to report in the area of prescription drugs, not much of which will bring joy to my pharmaceutical phriends.
First, following the money (hey, it's me, the health economist), AARP brings out its latest Watchdog Report which details the rising prices of 220 brand name Rx's most used by older people covered by Medicare Part D since the plan's inception two years ago. These prices have risen much faster than the rate of general inflation. The average price increase in 2007 was 7.4%, over 250% of inflation in the period (=2.9%).
For people with multiple chronic conditions, this translates into Real Money. AARP calculates that for someone on three medications for chronic disease management, the average increase in the cost of therapy since 2002 was $1,600.
Previous Watchdog Reports can be found here.
Kaiser Family Foundation's latest report, The Public on Prescription Drugs and Pharmaceutical Companies, looks into direct-to-consumer (DTC) advertising trends which were covered in a large cover story in USA Today on March 4. It's great to see coverage of this important issue in a mainstream mass media publication so people can learn about their behavior vis-a-vis TV ads. KFF continues to monitor DTC promotion through this project, the third poll that KFF has done with USA Today and the Harvard School of Public Health. The survey was done in January 2008. The key points of the study are:
1. When it comes to branded drugs, Americans love the products -- but dislike the companies who make them -- almost as much as they dislike health insurers and oil companies.
2. People say they are having a difficult time paying for drugs. 54% of Americans take prescription drugs: 50% of them daily, and 19% of them take 4 or more drugs.
3. Americans are split concerning who should be primarily responsible for develop prescription drugs: pharmaceutical companies, government and academic organizations share the role.
The high cost of drugs burdens consumers, and those who sponsor drug plans. PharmedOut.org specializes in "counter-detailing" -- that's the business of un-selling branded pharmaceutical produc
ts, and promoting generics. Early enthusiastic adopters of the un-detail are State governors. Why? Governors must balance budgets and still provide services to their constituents. Health care is the #1 or #2 line item for state spending. Thus, governors are keen to get control over spiralling prescription drug costs within that line item. My own state governor, Ed Rendell, has been a big adherent of this practice for the past two years. He has 10 trained "unsales reps" on the staff. It's all about efficacy and safety, they say. Oh, yes, and money.Dr. Jerry Avorn, author of the informative book Powerful Medicines was an innovator of 'academic detailing,' which is the accumulation of evidence on efficacy and safety of a drug and the presentation of that information to prescribing physicians. Avorn has cited a study that the un-detailing of acide suppression drugs has saved a state $572,000 a year in a move from prescribing Nexium toward generics, OTCs and Tums-type antacids.
Already, California, Colorado, Massachusetts, New York, Pennsylvania and South Carolina recently started an unsales program, and Avorn says California, Colorado, New York and Massachusetts are also considering them. New programs are developing Maine, New Hampshire and Vermont.
Health Populi's Hot Points: The fact that the most-prescribed drugs for seniors increased in price by 2.5x greater than inflation seems to be a real snafu by pharma companies. Could they feel less loved than they do now? On the other hand, margins are tighter than ever given the shallow pipelines for new-new drugs, so the companies are looking out for shareholder interests. Anothe tactic is that we see many of the largest pharmas shedding staff. My personal anecdote is that several people whom I consider some of the brightest lights in Big Pharma have left their positions for posts outside of traditional pharma: in biotech, new media, and consumer goods. A brain drain, coupled with lack of aggressive re-imagination of the pharma business, could further exacerbate the industry's turnaround.
posted by Jane Sarasohn-Kahn at
3:39 PM
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Published on www.brainblogger.com
Your Television as you doctor?
Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.
Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.
The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.
DTC advertising is also a catalyst for and similar to disease mongering.
Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.
Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.
“Do every act of your life as if it were your last.” ---- Marcus Aurelius
Dan Abshear
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May 28, 2008 4:12 PM
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