Body Wash and RFK, jr

Body wash and RFK, Jr

Life is full of many mysteries. For the longest I wondered what was “body wash”? Then someone told me it was liquid soap. Now why anyone would want to use a liquid rather than a bar of soap is beyond me. I guess they like seeing money wash down the drain because they will get fewer showers from a bottle of “body wash” than from a bar of soap. Another mystery is the avalanche of prescription only drugs advertised on TV. The warnings take longer than the commercial, but the ads are targeted to the public and not to doctors. You cannot walk into the pharmacy and getover the counter any of the ED drugs, Lyrica, Eliquis, Humira, Latuda, Xeljanz, Celebrex, or Chantix. (Who thinks of these names, anyway?) Yet the pharmaceutical industry spends $3.5 billion a year advertising prescription drugs to consumers. This is 76 percent of all their advertising dollars. It must be effective or else they would not spend all that money. I guess they figure that a person who has a particular condition will see an ad for a particular drug and then go ask their doctor for a prescription for it assuming that the doctor would not prescribe it.

The United States and New Zealand are the only countries that allow this type of advertising. Generally, advertising is intended to attract customers to the product. The advertising for drugs does the same but also must carry with it possible risks. None of this was legal until 1997 when the FDA authorized it. Perhaps it is not surprising that the FDA head who approved the ads went to work for a pharmaceutical company when he left the government.

Robert F. Kennedy, Jr, Trump’s nominee for the Department of Health and Human Services, wants to ban this advertising. He claims that the advertising leads to higher healthcare costs and over prescription of medications. Kennedy says “The constant barrage of drug commercials is not only annoying but also detrimental to public health. It’s time we put an end to this practice and prioritize patient well-being over corporate profits.” Sounds like Bernie Sanders.

That seems like an empirical question so is it true? Is drug advertising detrimental to public health? Research has shown that drug utilization is highly responsive to advertising exposure. Increased advertising also leads to more doctor visits per year. There was a positive association between exposure to drug advertising and intention to switch medications or engaging in behavior to find out more about the medication. One study finds “that advertising benefits both consumers and companies advertising the products. Consumers benefit through increased adherence to medications, greater engagement with the healthcare system and use of generic medications. Companies benefit from greater sales of their products and more favorable consumer opinions of the industry. We did not find much evidence that advertising discouraged healthy lifestyles or other non-drug treatments. We also found that price disclosures in advertisements, which have been suggested by policymakers, will have little effect on consumer behavior.” The study concludes that advertising benefits both consumers and pharmaceuticals. “In short, restrictions on advertising are not a silver bullet for reducing inappropriate use of drugs because these restrictions will also likely reduce appropriate use and reduce patient engagement. This body of research suggests that policymakers should proceed with caution as they design proposals to restrict advertising.”  

A clinical study on antidepressants found that the medications were prescribed far more often when the patients requested them.” In this community-based randomized trial, antidepressants were prescribed far more often when patients requested them. In addition, patients portraying major depression and making either brand-specific or general requests were more likely than patients making no request to receive minimally acceptable initial depression care. These results underscore the idea that patients have substantial influence on physicians and can be active agents in the production of quality. The results also suggest that DTC advertising may have competing effects on quality, potentially averting underuse while also promoting overuse.” https://jamanetwork.com/journals/jama/fullarticle/200780#google_vignette

How about that for weasel words? “Potentially averting underuse while also promoting overuse?”

In general, research shows that advertising is effective in that more advertising leads to more requests for the advertised medication which leads to more prescriptions. However, there is still the question as to whether the medications were necessary or not. Interestingly, research has also shown that the use of generics is not adversely affected by advertising.

Thus, although it is well documented that the price of advertised prescription drugs in the United States is over three times that on average for developed countries, generic drugs are generally cheaper in the US and ninety percent of all prescribed drugs are generic. I wanted to compare the US with New Zealand or New Zealand with other countries but could not find any data. However, I am not certain that I would have learned anything because I am not versed in the nuances of drug pricing. There are the insurance companies, copays, Medicare, Medicaid, government and private layers between the drug companies and the ultimate consumer. So the final cost direct to the consumer is rarely the list price of the drug. I don’t know how to compare apples with apples. Are we comparing the same drugs? Are drug companies more profitable in the US than in other countries? Many countries have price controls on drugs but that results in fewer drugs being available to the public. In the UK, their national health service will not pay for any therapies whose costs exceed $50,000 per year. Do we want that? Only 1 out of every 12.5 potential drugs ever reach patients, the average drug takes 11-14 years to develop, and the costs of bringing a drug to market are $1 – $2.5 billion. The drug companies always say that price controls would inhibit research on new drugs. 

In economics we study trade offs. With drugs we are looking at the trade off between today’s prices and profitability and citizens’ health in the longer run. Here the question is whether the lowering of drug company profits and drug prices today are worth the likelihood that more specialized medications for rare medical conditions will not be developed in the future. Any suggestions?