Despite my best efforts, every now and then an ad slips through on Hulu. (Yes, Hulu, sorry, I ignore your ominous notes telling me that I am a horrible person for using an ad blocker, but I refuse to be shown the same inane four ads over and over and over again in your increasingly long and painful ad breaks, which have gotten to the point where it feels like I’m lucky to be able to catch snippets of a show between ads. Since when has a 45-minute show taken almost an hour and 15 minutes to watch? But I digress.) I tend to just tune out for it, or actively mute it, because I’m not terribly besotted with advertising now that I’ve been exposed to more of it – in my teens, it fascinated me, now it’s just annoying.
What I’ve been noticing is that pharmaceutical ads are the most likely to penetrate my allegedly impermeable barrier, which is extremely annoying, because they are the advertisements that I probably hate the most. If I were given an option in terms of ads to be compelled to view, they would be extremely low down the list, and possibly at the very bottom – I’d have to sit down and carefully consider the matter before I could give you an authoritative ranking.
What I do know is this: I hate pharmaceutical ads, and I don’t understand why they’re allowed to air in the US. Many nations specifically bar them, which I would argue is a sound piece of public policy, and I wish the US did the same; given that we tightly regulate advertising and broadcast media, it would be far from impossible to implement a blanket ban on pharmaceutical advertising. Along with related activities like handing out swag to doctor’s offices, buttering up physicians with all-expenses-paid trips to ‘conferences’ where they’re primarily indoctrinated with information about the products specific companies manufacture, wining and dining people, and so on. I get it: Pharmaceutical companies want to sell things, and they want to take advantage of the narrow window when their products are still on patent, but this is ridiculous. There’s no good reason to allow the industry to continue effectively dictating what gets prescribed for patients, because that’s bad medicine.
The only area of pharmaceutical promotions that I have mixed feelings about is sample culture. On the one hand, samples fall under the purview of advertising, and they make me uncomfortable; I don’t like to think of offices being rained with free samples, and physicians encouraged to prescribe those medications by extension. On the other hand, using samples, can also be valuable for a test course of a long-term maintenance medication to determine if it’s effective before compelling a patient to spend a lot of money on a prescription. Samples are also immensely handy for low-income patients who can’t afford medication; what’s better, locking down samples and having patients become unstable because they can’t get their meds, or allowing sample distribution and providing another avenue for helping patients? (And no, Obamacare is not the solution to this problem, as illustrated by the numerous problems with the implementation of the ACA.)
Pharmaceutical ads irritate me for a multitude of reasons. One of the first is that they tend to medicalise every single condition, and suggest that everything can be solved with a pill. I am not, by any means, anti-pharmaceutical. I use a great deal of medication in my daily life. However, I rely on private conversations to determine which medications are appropriate for my needs, and I operate in the awareness that medical conditions are not one size fits all. Different medications, and dosages, work for different people, and I’m not just talking about the variability of psych meds, which are particularly notorious for this.
What pharma ads suggest to consumers is that they can run to the doctor for medication to fix what may be a complex medical issue. If an ad spurs a patient to get into the office, that’s great; for example, ads about urinary continence raise awareness about the fact that urinary incontinence is not actually normal, and that people who experience problems with frequent urination or mild incontinence (I hope that people with more severe incontinence would be calling their doctors) can and should seek treatment (and shouldn’t be humiliated by it, either). However, once patients hit the office, it’s not as complicated as ‘I want to start Taking Brandnamepeedrug.’ The patient needs to be evaluated, needs testing and a detailed discussion, and patients need to have conversations with their doctors about their specific symptoms before any course of treatment – medication, surgery, whatever – can be safely recommended.
It’s not that I think patients aren’t capable of making medical decisions (I don’t). Nor do I think that patients are incapable of researching their medical conditions, being aware of existing conditions, knowing what they need, and not being interested in a long haggling conversation – when I switched primary care providers, for example, I explained that I had reasonably well-controlled asthma, we talked about the medications I was using, and she effectively said ‘I see no reason to change what’s obviously working for you.’
The insidiousness of pharmaceutical ads, though, is that they make patients think that they’re required to take medication to handle every single aspect of their lives, and they suggest that medication should be readily accessible. That encourages polypharmacy, which is potentially dangerous, where a patient is taking such a mix of medications that interactions become almost impossible to avoid. As my psychiatrist puts it, her goal, and that of many doctors, is to have patients on as few medications as possible, at the lowest dose possible, to reduce the risk of complications, interactions, and side effects.
If I believe the ads I see, I have 16 different medical conditions that I definitely don’t recall having had before, and every single one of them requires immediate treatment with an expensive brand name drug. Something about that sounds weird to me when it’s coming from a company founded to sell such drugs, instead of my doctor – and as a patient at Kaiser, a results-oriented HMO, I know that my doctor is focused on my care, rather than racking up procedures, test orders, and other things to charge me (well, my insurance) for in the interests of making more money.
Image: Old-fashioned medications, Ruth Hartnup, Flickr