Direct-to-Consumer Meds

My nephew Zain, a medical student at St. Georges’ Medical College in London, visited us last month, bringing with him the topic for this blog. While watching television one evening, he made a comment about the excessive number of advertisements for prescription medications, noting how rare it is to see any medication advertisements in the United Kingdom. His comment made me notice what I was taking in stride before: an ever increasing number of direct-to-consumer television advertising of prescription medications. Even while writing this blog, I can easily think of at least 30 to 35 of these ads.

I can bet you that during a few hours of prime time watching, you are likely to witness Cialis, Crestor, Fosamax and Flomax ads, among others. Having personally worked in at least five other countries outside USA, I can not recall seeing any direct to consumer television prescription drug advertisements in Pakistan, Saudi Arabia, Ireland, England, or Iran.

To get a complete perspective of this issue, let’s take a look at some other statistics. American physicians are much more likely to prescribe new medications than their Canadian counterparts. They are also temporally much quicker to adopt them, rather than stopping to pause and ponder. I am not sure whether this reflects pressure from patients on their primary care physicians to prescribe what they see on television, or reflects the way pharmaceutical industry targets physician prescribing habits. Remember, new medications are likely to be extremely expensive, and have both a shorter duration of safety profile and inadequate post marketing surveillance.

Keeping this information at the back of our minds, let us now review the fact that we in the USA spend $5267 per capita on healthcare. Compare this amount with that spent by other ‘industrialized’ countries such as Canada ($2931 per capita) and England ($2160). Unfortunately, this additional spending does not necessarily provide us with better care. The life expectancy in both Canada and England exceeds that of America. Similarly, the infant mortality in the USA (6.5) continues to be higher than Canada (4.8) or England (5.2). While I have only compared us with England and Canada, this fact also remains true when comparing us to other first world nations such as Germany, Japan, and Spain.

This is not to say that direct to consumer advertising is the denominator responsible for the mess we find our healthcare in. More overt problems include socially acceptable extreme medico legal environment (USA performs 8.2 MRIs per million, compared to 4.2 in Canada and 4.0 in England), fee for service payment structure to physicians and for profit third party payers, etc. Direct to consumer advertising is definitely a contributing factor, though. With a new election cycle every four years, I would like to hope that a change is achievable. This year is no different. While healthcare, along with economy and Iraq, is on top of the list of issues on voters’ minds, both Clinton and Obama have been promoting differing versions of universal healthcare. Without going into merits of which one is better, what is exciting is the opportunity to change the statistics cited above, so we can spend less per capita but achieve better outcomes.