Global Matters: Drug abuse of a different kind
There comes a moment when you realize you've crossed over into another "demographic," when it hits you that you're no longer as young as you think you are, or as young as you feel. You discover that while you may think you're 39 years old, the world knows you're, well, not.
There's no surer confirmation that you've crossed over to the other side than when the television shows you watch feature advertisements not for fast cars or high-tech gadgets, but for pharmaceuticals.
Now, some television shows that I watch do include edgy ads, but I also watch "60 Minutes," and nearly every commercial on "60 Minutes" urges me to ask my doctor about various ailments ranging from high cholesterol to high blood pressure, from heart disease to restless leg syndrome, and to a host of, shall we say, male conditions known only by their initials or discrete abbreviations.
Putting aside for a moment the stark suggestion that I should now be more concerned with medication than with image, I am equally struck by the staggering sums spent by pharmaceutical companies on these advertisements. As we consider whether and how to reform our byzantine health-care system and how if at all we're going to pay for coverage for ourselves and the 47 million Americans as yet uninsured, it's worth considering just how much is spent advertising products to persons who are in no position to buy them.
I am not a physician and I couldn't buy or prescribe any of the advertised medications even if I knew enough to want to. Yet, presumably, simply because I am a consumer in a particular demographic I'm supposed to be inspired or concerned enough to ask my doctor if I'm a suitable candidate for a medication or treatment protocol with which I am likely only barely familiar, but utterly unqualified to suggest.
Why are the pharmaceutical companies advertising prescription medications directly to consumers? Why should a lay consumer be suggesting particular medications or treatments to a physician?
It may be that part of the answer lies in our "informed consumer" culture, which, in the context of health care, might have originated with patients being encouraged to ask their doctors if they actually needed a particular treatment, thus possibly leading to lower charges and greater savings.
It seems, though, that having empowered and now conditioned patients to inquire regarding their treatment, the pharmaceutical industry may be leveraging the consumer mentality to increase sales of medications that are particularly profitable.
We're not talking about nickels and dimes.
According to the Nielsen Co., in 2008 pharmaceutical companies spent more than $4.34 billion on direct-to-consumer advertising.
It's true that this figure represents a decline of 18.4 percent from the 2007 total of nearly $5.33 billion. A decline of nearly a billion dollars is significant.
But, really, how many billions need to be spent on advertising to consumers who cannot themselves go out and purchase the products being advertised? Mightn't the cost of pharmaceuticals be lower, if these advertising costs were reduced or eliminated?
It's not as if the drug manufacturers don't have other means by which to communicate the efficacy or desirability of their products.
According to a 2007 study published in the New England Journal of Medicine, pharmaceutical companies in 2005 spent $6.77 billion on "detailing," i.e., providing drug information to physicians; an additional $18.4 billion providing free samples to health care professionals, and $429 million advertising in professional journals.
All in all, in 2005, pharmaceutical companies spent nearly $30 billion in professional promotion alone. There's no doubt that they are getting the word out to those in the best position to make medical decisions.
So, I can only conclude that I'm missing something.
I'm sure someone can explain to me that annual direct-to-consumer advertising in excess of $4 billion is money well spent, and I'm certain that the pharmaceutical industry can mount a robust defense of professional promotional spending.
But at a time when policy makers are working hard to find savings in our health-care system so that more of the 47 million uninsured Americans can get coverage, we could probably manage with a little bit less dedicated to advertising and a little bit more dedicated to increasing access to medications and enhancing coverage.
I'm not sure how, if these ads were pulled from the lineup, "60 Minutes" would fill all of the resulting dead air on Sunday nights, but I'd be more than willing to sit on the couch and wait quietly for the show to resume.
At my age, I never miss an opportunity to take a nap.