Ask Your Doctor About…

One of the largest and most rapidly expanding areas of research is drug development. Though the morbidity of infectious diseases plummeted in the latter half of the 20th century, the amount we spend on prescription drugs is increasing year after year according to a 2008 study by Aitken, Berndt, and Cutler (Aitken, Berndt, Cutler 2008). The study looked at spending habits from 1997 – 2007 and uncovered a trend of increasing growth averaging 9.9%. The study also found that the number of blockbuster drugs surged at the turn of the new millennium. Blockbuster drugs are drugs that become extremely popular and profitable, generating over $1 billion in annual sales. Examples include Vioxx, Lipitor and Zoloft, medications which are likely familiar to the average American thanks to their massive advertising budgets. Blockbuster drugs have redefined pharmaceutical advertising, prescribing, and regulation. But in the politics of big pharma, is it the patients or the companies who win?

        A good deal of marketing goes into producing drugs with mass appeal. This includes the Average Joe as well as his physician. Often, commercials for these drugs end in the phrase “Ask your doctor about ______”. Despite the possible illusion, these marketing strategies aren’t targeted to individuals who are knowledgeable about the ins and outs of medicine. Commercials like this are designed to stimulate hype about a drug within the general public, or to even make the brand a household name. It is obvious that frequent exposure to a product in advertisements makes one more likely to remember that product in the future, but exposure manipulates the brain in other ways as well. The mere-exposure effect is a psychological phenomenon that stipulates we are more inclined to have a positive association with something the more we are exposed to it. In other words, familiarity drives positive feelings toward a product. This is the basis of subliminal messaging, and advertising campaigns use it to promote blockbuster drugs. The more we hear the name Humira, the more alluring the drug becomes.

        But surely the prescribing physicians are not affected by these advertising campaigns in the same way as the average consumer? They are trained to practice in the most objective way possible, right? It may be true that doctors are more knowledgeable about the things they prescribe, but they are still susceptible to the Blockbuster advertising campaigns. When a patient recounts their symptoms and a drug that might be able to help, a physician is more likely to consider the drug for treatment. A collaborative study between the New England Research Institutes and Harvard found that when a drug, like Oxycodone, was mentioned in a patient-physician interaction, the chance that the patient would receive the requested drug rose from 1% to 19.8% (Mckinley et. al, 2014). This was also seen in non-ideal cases, in which Oxycodone would not be beneficial to the patient based on the described symptoms. This large jump in prescription outcomes can be justified by the power of suggestion and advertisement. The patients see the repetitive advertisement of different drugs and then exert their power of suggestion on the physicians, who unwittingly buy into the system. Additionally, blockbuster drug companies advertise directly to physicians and practices, offering financial incentives for preferentially prescribing their products. A 2014 ProPublica analysis determined that doctors who received funding from drug and medical device companies were more likely to prescribe name brand drugs to their patients (NPR). Whether this is due to agreements between doctors and pharmaceutical companies or the mere-exposure effect, it suggests that doctors are not immune to blockbuster advertising.

        The buzz surrounding the drug development system is precisely what encourages drug companies to race to find the next blockbuster drug. There is a self-perpetuating characteristic in the profit generation that stems from these ultra-successful drugs. As drugs make more money and are used more frequently, they acquire credibility and a dogmatic reputation. The 21st century has seen ever increasing presence of Blockbuster drugs, due to the capitalist culture and pressure for patients to become more involved in their medical care. The future of drug development and pharmaceutical companies hinges on the continual creation of these money makers.

However there is a danger that comes with this dash for cash. The faster a company can get a drug past trials and out into the market, the faster they can fill market space. There is a lot riding on the timeline of events, and companies will do anything to speed up the process. However, the FDA is a hindrance to these corporations. Many cite the advancement of innovations, such as protease inhibitors spawned from the AIDS crisis, as justification to loosen regulatory standards. The creation of the FDA’s Accelerated Approval Program enabled the fast-track of experimental treatments and many lives were saved because of it. Over the years, the FDA has undergone many reforms to improve the efficiency of which drugs are evaluated, but that is still not enough for some. Efforts, like the 21st Century Cares Act passed in December of 2016, seek further deregulation of the drug approval process.

        It is important to keep in mind who benefits from reducing the difficulty of drug development. Some patients will have more immediate access to the latest treatments, and that could potentially save more lives. However, deregulation of the drug approval process raises serious concerns regarding consumer safety. Are lives now at risk because of careless approval practices? Will bribery by blockbuster developers be even more influential in the approval process? These are significant questions but in my opinion, it is essential that we do not sacrifice overall well-being for the bottom line.


REFERENCES

  1. Aitken, M., Berndt, E. R., & Cutler, D. M. (2008). Prescription Drug Spending Trends In The United States: Looking Beyond The Turning Point. Health Affairs,28(1). doi:10.1377/hlthaff.28.1.w151
  2. Mckinlay, J. B., Trachtenberg, F., Marceau, L. D., Katz, J. N., & Fischer, M. A. (2014). Effects of Patient Medication Requests on Physician Prescribing Behavior. Medical Care,52(4), 294-299. doi:10.1097/mlr.0000000000000096
  3.  http://ovidsp.tx.ovid.com/sp-3.24.0a/ovidweb.cgi
  4. QS2=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
  5. Npr: http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

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