Do You Ask Your Doctor If Brand X is Right for You?

America is quickly approaching another anniversary. It's been nearly 10 years since drug companies have been able to market prescription medications directly to consumers. Back in the day peoples' jaws dropped when former Presidential candidate Bob Dole became the spokesperson for that revolutionary blue pill. What a stiff! (pun intended)

Nowadays you can't make it through the nightly newscast without 5 or 6 commercials for prescription medications to help you sleep, to relax your bladder, to strengthen your bones, and to reduce cholesterol.

How ironic to commemorate this "anniversary" with the disclosure that a very prominent physician who promotes a top-selling prescription drug is under increasing scrutiny for his marketing efforts. There is no need for any spoiler alert - you'll figure it out sooner or later. It could not have occurred at a better time because it typifies all that is wrong with our so-called managed health care system. I do not want to further skewer this individual but his embarrassing situation may help America launch a long-overdue debate about the future of our health care system.

The physician-pitchman was never a licensed practicing clinician yet he wore a long white coat in the ads. This physician claims the commercials are actually 'patient education messages' yet treatment options like cheaper generics are never mentioned. Some education! Disclosures regarding his generous compensation never appear in the commercial yet the physician made a fortune encouraging viewers to ask their doctor to initiate treatment.

Direct-to-consumer marketing works. One study documented that doctors obey their patients and write new prescriptions 40% of the time when requested even in the absence of legitimate indications. This takes the practice of medicine and stands it on its head. Nielsen ratings now have a greater impact on the quality of USA health care delivery than do JAMA or The New England Journal of Medicine!

A generation ago a patient described their symptoms, the doctor performed an examination with appropriate testing, and prescribed the necessary treatment based on the established diagnosis. Critics saw this approach as too paternalistic, lacking sensitivity to the patient's needs. The new paradigm appears to be: advertising, patient inquiry, new prescription. Since today's clinician only gets 6-minutes per patient this almost makes sense.

According to ABC News, New Zealand is the only other country on this planet that permits direct-to-consumer prescription drug marketing. That's interesting because NZ has a highly socialized health care system wherein doctors can only prescribe what is available on the approved formulary. Under our system there are limitations as to what (and when) new drugs are dispensed but, in general, most physicians have the necessary wherewithal to provide what their insured and self-pay patients want.

Attention policy wonks: a GAO report notes that prescription medications continue to be the fastest growing (read least controlled) segment of health care spending. Direct-to-consumer advertising is an enormous revenue engine for drug makers. Sure, they still budget plenty to persuade health care providers of product and brand superiority; that hasn't changed. What has changed is the methodology by which the experienced clinician is able to decide which medical treatment best suits the needs of the individual patient. For at least 40% of American doctors, TV commercials make that call.

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