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Direct to Consumer Advertising and Health Care Costs

By on February 13, 2012

In the 1997, the Federal Drug Administration sanctioned direct-to-consumer promotion of drugs on broadcast media for the first time. They did not require that these advertisements balance risks with benefits. Risks could be fired off in machine gun fashion as viewers tried to figure out what these drugs were supposed to do. The FDA did not monitor these ‘promotions’  for clarity of message, but adopted a wait-and see-attitude.

The FDA was held in high regard then, rightly been honored as the main bulwark against ‘snake oil salesmen’ in the marketplace. A decade earlier, their spotless record had been slightly dented by controversy about the slowness to approve anti-HIV drugs in the pipeline for experimental use. But it was only a dent. They had been a valuable watchdog agency for decades

The pharmaceutical industry went wild. Drugs that had once only been hawked to doctors to influence their prescribing habits, now hit the TV screen in lavish, fluffy spots designed to make consumers ask their doctor if they should be taking them. The indications for prescribing were often vague, and somewhat misleading. Attractive models gamboled through fields and meadows as patients scratched their heads. Doctors reported a sharp increase in specific demand for the advertised prescription drugs almost immediately.

In addition, so-called  life style drugs became bigger. Toe nail fungus was no longer to be tolerated. Sexual performance could be enhanced. Male pattern baldness could be reversed — somewhat. The message was clear, whatever ailed you, there was a drug that would make you feel better about it. And the media was there to keep viewers aware of them.

Meanwhile on the 10 o’clock news,  the unwritten ban on medical ambulance (or patient) chasing was disappearing. In every large market, hospitals, medical groups and treatment centers began hawking their wares. Suddenly the sleepy community hospital down the road was  a “world-class” heart center. Doctor teams were “cutting edge.” Specialty programs were “award-winning.” It became impossible for patients separate the hype from fact. A hospital that did not advertise was in danger of being ignored. In 2012, radio ads for hospitals are unavoidable.

Studies done since 2005 have demonstrated while patients are aware of these products, they are not clear about their indications and not knowledgeable about possible risks and side effects. The downside is that DTCA (direct to consumer advertising) has added to the already high costs of health care in the US.

That ad for the Shady Dale Wellness Center has added to the cost of a visit there. That anti-depressant you saw sandwiched into Hot in Philadelphia will cost more because of costs of promoting and advertising it. Someone has to pay for all this promotion and you get only one guess who that is.

If you talk to practicing physicians, the complaint about patients coming in demanding drugs are many. In a study reported in the American Journal of Family Practice, doctors reported that 56% of their patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test or new medication, or a referral to one of those ‘world class’, ‘cutting edge’ centers.. The doctor felt 49% of these requests were clinically inappropriate. Nevertheless physicians filled these requests deemed clinically inappropriate 69% of the time.  Only 13% of those doctors surveyed thought DTCA has been helpful.  

Ask yourself, has direct-to-consumer advertising added to the public’s knowledge of medicine and the marketplace? Probably not. Has it added to the cost of over-all health care in the US. Definitely.

Estimates of the added cost of direct to consumer advertising passed on to the patient range about 11 to 12% of the total cost. That means 12 cents of every dollar you are spending on care is going to these direct to consumer ads.

Defenders of the practice argue this is their first amendment right. Critics argue, that if there is a serious attempt to cut unnecessary costs, start here. You decide the value the DTCA. My guess though is that the writers of the Constitution did not envision freedom of speech as the right to pile-drive your message endlessly through every commercial break. Of course, none of them had cable. Maybe that was the problem.

Tom Godfrey

About Tom Godfrey

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