I have come to the conclusion that direct-to-consumer (DTC) advertising by pharmaceutical companies is a very bad idea and should be prohibited or more closely regulated (see: Effectiveness of "Direct-to-Consumer" Drug Advertisements; It's Time for the FDA to Prohibit Direct-to-Consumer Advertising by Pharmaceutical Companies). In my opinion, this marketing channel offers the industry too many opportunities for dirty tricks (see: Rigged Depression Survey on the Web Steers Readers to Lilly's Cymbalta). These companies employ an army of clever people who spend all of their time figuring out how to confuse and manipulate healthcare consumers who are at a distinct disadvantage. A recent article discussed how disease symptom check lists have become a marketing tool to increase drug sales (see: Have These Symptoms? Buy This Drug). Below is an excerpt from the article:
Are symptom checklists more for marketing than diagnosis? Are symptom checklists more for marketing than for diagnosis? It began suddenly a little over 10 years ago....The questions [that healthcare consumers began to ask about] drugs did not reflect breaking news or the results of scientific studies. Rather, they were a reflection of sound bites, advertisements and the draw of celebrities who endorsed them, all part of carefully conceived marketing schemes....[I]n 1997, when the Food and Drug Administration loosened its regulations and the United States became one of only four countries to allow direct-to-consumer advertising (the others are New Zealand, Bangladesh and South Korea), we entered a new era in pharmaceutical consumerism. Players in the drug industry began aiming their advertisements at patients, and their goal was to define in the minds of patients not only the beneficial effects of the drugs but also the diseases they were designed to treat. As Vince Parry, a well-known marketing expert, counseled his colleagues, “If you can define a particular condition and its associated symptoms in the minds of physicians and patients, you can also predicate the best treatment for that condition.” The phenomenon is sometimes referred to as “disease mongering,” redefining what is normal and abnormal in a way that widens potential markets for those who sell treatments. And, as detailed in a recent study in the journal Social Science & Medicine, one marketing strategy has accomplished more in this regard than any other by using what has come to be the very symbol of quality and reliability for doctors and patients everywhere: the checklist. Placed on Web sites, on downloadable apps and in pamphlets in doctors’ offices, these checklists of symptoms have become a critical part of every major pharmaceutical marketing campaign. What makes them so attractive is that they make it easy for patients to diagnose their own ailments, to take some control over their own health. What makes the checklists so powerful is their ability to influence patient preferences....“The whole point of tools like this one is to confine people’s experiences into these categories in order to make a diagnosis in line with the branded drug,” said the author of [this recent study about checklists].
The connection between these disease checklists and disease-mongering is interesting. I have addressed this latter topic in previous notes (see: Disease Mongering (i.e., Medicalization) by Pharmaceutical Companies; Medical Device Mongering, a Variant of Disease Mongering). All of this reduces in my mind to the following: the pharmaceutical industry, through its DTC marketing, is expanding the definition of disease in the minds of consumers; this provides incentives for consumers to self-diagnose their own illnesses; these consumers are then persuaded to request treatment of these diseases with the advertised drugs.
I need to emphasize that I am strongly in favor of educating healthcare consumers (see: Educating Healthcare Consumers as an Indirect Measure for Educating Physicians; Teaching Consumers to Say "No" to Physicians' Recommendations; Paging Dr. Google! We Are Waiting for a Second Opinion). I believe that it's important for patients to be able to have an informed dialogue with their physicians. However, with disease mongering and these disease checklists, it's not about educating consumers but rather about manipulating them. Needless to say, all of this clouds the interaction between physicians and patients. However, the influence of the pharmaceutical companies over physicians is decreasing. Drug sales reps are not allowed in most hospitals. As a cost-containment measure, the companies are also reducing their sales staff and depending more on e-detailing and e-sampling (see: How E-Detailing May Lead to Greater Knowledge by Physicians about Drugs; E-Sampling: Another Blow to the Future of Pharma Sales Reps). If you watch TV, start paying attention to the number of DTC advertisements you see in prime time. This is a big problem.
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