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Brand-name shoppers

September 2008

As a practicing physician, there are many time when I say to myself, “Thank goodness I chose to become a hospitalist.” (There are also plenty of times when I ask, “Why did I do this to myself?” Definitely a topic for another blog.)

One of those moments of self-congratulation came recently when I was admitting a pleasant, elderly patient with pneumonia. I reviewed her medications and found that she was on Plavix. She had no history of coronary artery disease or cerebral ischemia but she did have risk factors for arteriothrombosis. When I asked her why she was on this medication, she told me, “I saw a commercial on TV about it. I did not want to have a stroke so I asked my doctor for a prescription.”

I don’t know whether or not my elderly patient went to www.plavix.com, but if she had, she would have found a handy list of “questions to ask your doctor.” Seventeen questions in all, but three were pre-checked (how convenient!)–the idea being, I guess, that if you have time to ask your doctor only three questions, these are the ones to run with.

Included were “Am I at risk for a future heart attack or stroke?” and “Can Plavix give me more protection against a future heart attack or stroke?” Maybe the pharmaceutical industry actually wants something from us in return for all those free pens!

Of course, online advertising is only the tip of the iceberg, as demonstrated by my Plavix-taking patient. Direct-to-consumer (DTC) advertising has strongly influenced the way outpatient doctors practice medicine, and I suspect that most of our office-based colleagues would say the change has not improved their profession.

Initially banned by the FDA, DTC advertising has exploded over the last five years. The pharmaceutical industry currently spends more than $4 billion a year on DTC promotions, the majority going to TV and print ads. These ads concentrate primarily on drugs for chronic conditions like asthma, allergies, impotence and high cholesterol. At least Lipitor let go of the ubiquitous Richard Jarvik; I was at risk for suffering a stroke myself despite my excellent cholesterol profile.

In 2006, the government accounting agency issued a report that demonstrated two very interesting facts. First, for every $1 spent on DTC advertising, sales of that medication class shot up by a median of $2.20. Second, between 2% and 7% of consumers who view pharmaceutical commercials go on to request, and ultimately receive, a prescription for that medication. For those interested in this subject, I would strongly suggest reading an NEJM editorial from last year that explores in depth the failure of the FDA to properly regulate drug ads.

My interaction with my pneumonia patient reminded me that I am happy to be a doctor who does not have to debate with patients about the value of medications based on ads that convey information via, say, a cartoon of a dancing toe fungus. To date, I have never had a septic patient request Maxipime or someone in respiratory failure say they want to be sedated only with Propofol.

However, given the growing reality of DTC advertising, it may be only a matter of time before a community-acquired cellulitis patient demands Zyvox by name. In the meantime, I will count my blessings that there are no ads on during the 6 o’clock news that tout the efficacy of any drug for MRSA … yet.