“Talking about drugs is bad, ‘mmmkay?”
There was quite a heated debate after Antoine gave his talk at What MySpace Means on Wednesday, which was about the regulation of free speech. Specifically, he talked about how three major areas - money (banking, savings, gambling), power (lobbying and political advertising), and wellness (surgery and medicine) - are highly restricted in terms of companies or organisations being able to have direct conversations with customers.
This is often called ‘direct to consumer advertising,’ but if you really do buy into the idea that markets are - or should be - conversations, you need to cut the crap and call a spade a spade: These conversations are banned in many places (the EU included), and there are a lot of people who don’t want you or me to be able to hear from these companies about what they do. Antoine was talking about how ‘direct from consumer’ conversations are one way that these companies are getting benefits from online communities and getting around the laws.
Getting around the laws. Hmm, remind you of anything? Well, it reminds me of something Adriana spoke about earlier in the event, when discussing online people, aka ‘digital immigrants’. Let me quote from journalist David Tebbutt’s notes from our conversation:
Censorship or control are perceived as ‘damage’ and will be routed around. In this space, the demand side is supplying itself which has huge implications for traditional information providers.
And so it goes with people who are online and seeking information about medicines and surgeries.
Damian Counsell, who so graciously helped me out with people handling for the event, is (or used to be, depending on whether you ask me or him; I say he is, he says he used to be) a scientist. He thinks that companies should be banned from advertising medicines or surgeries to people, because pharmaceuticals are complicated things and most people do not have the sophisticated knowledge to understand what’s good for them in this area. (Damian, please do correct me if I am mis-stating your point of view.) Suw Charman also piped up to agree with Damian, and seemed horrified at the notion that drugs might be advertised. When I said that, well, they’re advertised in the US, Suw snapped, “Just because it happens in America, it doesn’t mean it’s a good idea.” Which…wasn’t at all what I meant. (I can forgive Suw her snappishness, as she was suffering both dental pain and an oncoming migraine.)
What I am asking Damian, Suw, or anyone else who agrees with them is to tell me in exact terms what the disastrous consequences of pharma advertising in the US have been. I mean, apart from every magazine having at least ten pages of full page ads for some allergy medicine or birth control pill. If you can cite a specific case where someone has seen an advertisement for a medicine and then come to harm, even better.
Another question, considering that Antoine’s presentation covered examples of how people are having these conversations amongst themselves online (and offline, for that matter). In light of the view that people are not informed enough to receive information about medicines and surgeries, lest they somehow - and I am still waiting to learn how this has happened or may happen - come to harm, then shall we ban people from discussing these things with one another? I mean, I am a lot more swayed that I should try Ambien for my sleepless nights when my friends - and there are many of them - sing its praises than I am by any advert for the stuff. Considering that I do not have a medical degree, and nor do most of these friends, should our conversations about medicines be regulated? Should my friends who have had surgeries also be barred from discussing those with me?
Filed under: Life
I didn’t want to make the blog post any longer than it need be, but I’m also interested in hearing from opponents of pharma advertising what they think the legal penalties should be for those who violate the regulations. If the stakes are so very high, are we talking the death penalty, lifetime jail sentences, or just some multi-million pound fines to teach the pigdog capitalists what’s good for them?
Also, considering that so many people are quite clearly making very stupid choices about what they eat and how much they move, thus endangering their lives, what is your stance on enforced exercise and state-regulated diets?
“Oh, don’t be silly,” you might respond. But that’s kind of how I feel when I hear that we need to be ‘protected’ from ads for medicine.
Jackie asked:
“What I am asking Damian, Suw, or anyone else who agrees with them is to tell me in exact terms what the disastrous consequences of pharma advertising in the US have been.”
I can do better than that. I can give you an example of disastrous consequences of pharma advertising in the UK.
I used to treat my hayfever with a miraculously selective anti-histamine called terfenadine (brand name Triludan, I think). Its advertising made great play of how safe and powerful it was, but didn’t give (stupid) people sufficient warning of the side-effects of overdose for those with heart conditions. A bunch of people died. The drug was withdrawn from OTC sale.
I and many other fans of terfenadine now have to treat ourselves with inferior products—unless we can give our GPs a damned good reason why we should be allowed to take terfenadine.
Outcome of unintentionally misleading (but perfectly legal) advertising: avoidable deaths and a reduction in consumer choice. And terfenadine has very low toxicity, is taken for very short periods of time, and its users could hardly be described as desperate or terminal—so I think the effects of allowing DTC advertising could be far far worse than that very easily indeed.
Sorry, no decent here. A lot is done in the name of protecting the public. Also, I tend to react to statements like the public don’t have the expertise or ability to understand issues that affect there own health.
No, no, no - that simply means the information hasn’t been made available freely or isn’t in the form that is easyily accessible.
One of the world’s greatest Physicists Richard Feynman repeatedly got irrited with his peers for failing to deliver lectures on Astro Physics that not only taught undergraduates, but also used language and explnation was engageing and accessibile for all.
Having worked for Astro/Zenecca (I guess that immediately makes me partial) for 3 years, I know there are many more effective ways to protect the public from harmful drugs than to ban advertising.
One of the many reasons drugs are rushed to market is to do with the length of the trial as a proportion to the length of a patent granted.
Let’s say that some drug company believes it has the cure for prostate cancer. The moment in early development/testing results look promising the Pharma patents the drug (potentially getting a 15 year patent and therefore exclusivity before it is replicated at lower cost by the generic drug vendors).
A trial for a drug like that could be in testing for 10 years or more, therefore the commercial pressure on a Pharma like Astra would be there to get it to market quickly so they can gain a couple of years of premium sales and earning. A week earlier to market for say a beta blocker could mean £1m.
A simpler way to protect the public (not that I believe they need protecting) is to extend the mandatory clincial trial period by 1-2 years and lengthen the patent granted.
Banning advertising doesn’t do it for me. Life always finds away - the amount of personal posts on blogs I’m sure is inversely proprotional to the amount of regulated off the internet. The more I feel is censored, the more I’ll talk about it.
Damian, it seems to me that the problem in your example was that the company in question did not make abundantly clear to people how they might be negatively affected by their OTC product. I’m still waiting to hear what disastrous effects the permitted - but regulated - advertising of prescription drugs in the US, for example, has brought about. If we’re talking bans on certain speech, we need to have some pretty good reasons for them.
Personally, I think that as long as pharma companies are not defrauding people, and as long as they ARE making clear all of the potential side effects, we have no problem. After all, it’s not in any company’s interest to kill their customers. And frankly, I’d rather people be on the alert for themselves than always assuming that “Well, there can’t be any risk here, because the government would have protected me from it!” This is the same problem we see with the airport ’security’ measures that are, for the most part, pretty useless. People are themselves less aware of potential dangers because they think someone else is taking care of it for them.
Jackie said:
“Damian, it seems to me that the problem in your example was that the company in question did not make abundantly clear to people how they might be negatively affected by their OTC product.”
That’s because it wasn’t in their interests to do so. That’s the nature of advertising. Unfortunately, patients read advertising, but they don’t read instructions.
The advertising (correctly) described the drug as “safe”, meaning “you can take it and operate heavy machinery because it is so specific for the relevant histamine receptors”. The patients read the word “safe” to mean: “you can exceed the recommended dose because it’s so non-toxic”. Nobody acted out of malice, but people died. Fewer people would have died if the only information about the drug had been the information in the accompanying instructions. There the wording is much more tightly regulated and it is in the drug companies’ interests to be thoroughly open and honest. If direct drug advertising were legalised, but as tightly controlled as drug instructions no drug company with any sense would waste money using it to sell their wares.
One of the first things you learn when you are taught about prescribing is that “patient non-compliance” is terrifyingly high—something like a third of patients simply don’t take their drugs the way they are told to do (or take their drugs at all). Worse, many patients take drugs according to the advice of ignorant relatives and friends.
If people pay more attention to iPod adverts than they do to the instruction manuals that come with their iPods that’s no great disaster. But there are very good practical reasons (with very serious documented consequences) for making sure that patients’ principal source of information about a drug are the approved instructions that came with it and the advice of their doctor.
We have to control drug advertising for the same reason we have to control scientific publication. Babies have died of measles because Wakefield “published by press conference”. People paid more attention to the media than they did to their doctors and suffered as a result. It’s now clear that Wakefield had a real financial interest in his work being reported prominently, just as the editor of the Lancet had a financial interest in getting the name of his journal on the front pages of the dailies, just like the drug companies would have a financial interest in spinning the attributes of their medicines. Incentives matter.
There’s a reason why US blood banks had worse problems with HIV contamination than UK ones: US blood banks paid their “donors”. The best sources of blood—just like the most best sources of information—are disinterested ones.
The free speech issue is a red herring. People sharing advice about drugs on the Web cannot be regulated, but they are either disinterested or have the interests of fellow sufferers at heart. Drug companies advertising drugs, by definition, are not disinterested. That’s fine. I’m happy for them to make a profit and wouldn’t want to stop them from doing so, but it inevitably makes them unreliable sources of information about the sources of that profit.
Regulating their advertising would not solve this problem for the same simple reason that regulating patent applications doesn’t solve the problem of intellectual property law throttling individual innovation: big businesses can afford better lawyers than government regulators.
I guess I’ll just keep asking until I get an answer: What have been the disastrous results of legal pharma advertising in the US?
Also: If the patient has to go through a doctor to get the drugs anyway, is your real worry that doctors don’t know what’s good for patients either?
Jackie wrote:
“I guess I’ll just keep asking until I get an answer: What have been the disastrous results of legal pharma advertising in the US?”
I’m not arguing about pharma advertising in the US; I’m arguing about it in the UK. That’s where Antoine, you, and I all live. That’s where it’s still a live issue because it is already banned (and you would prefer it unbanned). That’s where I’ve been educated. That’s the health system I best understand.
US public health provision is radically different from that in the UK. (This isn’t to say that I am in favour of DTC advertising there either; it’s just that I’m not sufficiently familiar with the culture to argue about it sensibly and, anyway, it’s none of my business.) You are of course welcome to discuss pharma advertising in the US—it’s your blog. And if that’s what you’d like to do I’ll go and have a cup of decaff instead.
Using the United States as an example to discuss the general question of control of drug advertising is like citing Switzerland or Bolivia in a debate about gun control.
Besides, why should something be shown to have “disastrous” consequences before we can ban it?
Jackie wrote:
“Also: If the patient has to go through a doctor to get the drugs anyway, is your real worry that doctors don’t know what’s good for patients either?”
Patients have to go through qualified pharmacists to buy OTC drugs, pharmacists who are often better informed about drug side-effects than doctors. That doesn’t undermine my example or my argument. People pay more attention to adverts than they do to pharmacists or doctors and the consequences can be fatal. Just ask the National Poisons Information Service or visit a lung cancer ward.
(In fact, I recommend that all confident, logical, well-off libertarians spend a few weeks in an accident and emergency department getting up close and personal with the horrific consequences of human stupidity—just as I would it recommend it to “safety Nazis” who don’t understand that ten simple rules are better than a hundred complicated ones. Smartarses like us argue in the abstract in poky comments boxes. Real people deal with the material consequences when our peers make policy.)
Oh, Damian. It seems our fundamental disagreement here is this: I believe people should be allowed to do stupid things, people should be encouraged to make their own informed decisions, and any laws we make to try to stop either of those things are immoral. I also believe that people are worse off for such laws. You don’t believe this. End of.
But I do think it is intellectually dishonest to tell me, in the abstract, all of these reasons why drug advertsing cannot ever be allowed, yet when asked to cite an example of the disastrous effects that drug advertising has had in a place where it is allowed, to say, “Well, we don’t live there, so it’s irrelevant.” Come on, now.
You do not need freedom to be smart. Nobody ever wants to stop anybody from doing sensible things. Freedom means being free to be stupid.
Talking of smart, sorry to be short and sweet, but I’ve got to rush away to rinse off this Dr Ken Dodd’s patented scotum botox lotion I sent away for. It’s beginning to sting a little. I saw an article about it in the health and wellbeing section of the colour supplement. Leslie (Knotty) Ash swears by it apparently.
Speak of the devil…Mark, I was just talking on the phone about you with Patrick Crozier. I brought back comments in part because yours were always so good, so thanks for piping up!
Jackie said:
“But I do think it is intellectually dishonest to tell me, in the abstract, all of these reasons why drug advertsing cannot ever be allowed, yet when asked to cite an example of the disastrous effects that drug advertising has had in a place where it is allowed, to say, “Well, we don’t live there, so it’s irrelevant.” Come on, now.”
Argh! I cited a concrete example of drug advertising having a disastrous effect in a place where you would like it to be allowed. It’s actually impossible to conceive of something more relevant to the question at hand.
I can’t believe I’m having to spell this out (to a bright spark like you of all people), but, imagine we had been arguing about whether or not it would be dangerous to introduce driving on the right-hand side of the road in Britain.
You ask me to cite an example where driving on the right has had disastrous consequences in the US. I say, “I can do better than that: we tried driving on the right on the Isle of Sheppey once—fifteen people and a dog died horribly.” Then you accuse me of being “intellectually dishonest” and “talking in the abstract”. Gah! If you weren’t harder than me, Jax, I’d be on the train to London to give you a wedgie.
Mark said:
“Freedom means being free to be stupid.”
I would mind that less if it were only the “stupid” people who paid the price, but, as in my MMR example, it’s frequently people who are in no position to be smart or stupid who are the victims of errors in drug administration. Babies and the infirm are, unsurprisingly, important and vulnerable consumers of drugs. Do they deserve to die for their carers’ “freedom to be stupid”?
Sometimes I don’t know who lives more in a theoretical fantasy world of human behaviour: Marxists or libertarians.
Damian, I honestly did not think that you were seriously arguing that a handful of deaths in a case where the obvious problem was *misleading* advertising was sufficient evidence that all drug ads should be banned. My bad.
“Damian, I honestly did not think that you were seriously arguing that a handful of deaths in a case where the obvious problem was *misleading* advertising was sufficient evidence that all drug ads should be banned. My bad.”
Dang. You got me there. I didn’t factor in that in libertarian fantasy world there would never be any misleading drug ads—after all, it’s all about *information*, not *selling*, and it’s not as if money ever tempted people to bend the truth.
The example I cited resulted in “a handful of deaths” (as you cheerfully dismiss them) because the drug in question was, as I pointed out, of very very low toxicity—unless you had an arrhythmia of course, in which case it was of very high toxicity. Most prescription drugs are *not* of low toxicity. That’s one of the reasons why they’re prescription drugs.
There’s the difference between science and politics:
Scientist runs small trial and people die—decides to discard approach.
Political theorist runs small trial and people die—decides that deaths were result of anomalous conditions and resolves to kill more people until approach shown to work.
You’ve got to understand that I am not making this case because I have some socialist axe to grind: I am obsessively in favour of the freeing of biomedical information and opposed to regulation for its own sake. I am making this case because the evidence I have seen shows that DTC advertising is dangerous and inefficient. I didn’t use this argument because it only applies to the US system, but over 80 percent of doctors there prescribe a drug if pressured by their patients. Very often patients press for a branded drug when a generic would be just as good in treating their condition—and would almost certainly have a more widely tested record of safety [The Economist].
Only in the USA is DTC advertising permitted and the USA also happens to prescribe drugs less efficiently (as GDP spend per life expectancy) than any other country on earth.
[Damian wanders off to take overdose in exasperation.]
Damian, if you think I’m “cheerful” about people dying, I can only tell you to adjust your cheer-o-meter.
I think that I do understand your argument - I just do not agree with your conclusion. You value different things than I do, which is fine. I value freedom more than I do peoples’ ‘right’ to be free from critical thinking.
Granted this issue is one that a) I never knew existed and b) isn’t particularly high on my list of priorities. But it strikes me however that there exists plenty of legal and not-so-legal ways of really hurting yourself medically anyway - all sorts of quack medicine is enthused about in the Sunday papers, extraordinary claims are made for bullshit treatments. People are free to try them out but then people are also free to stand up and say, “Dr Dodd, your patented scrotum botox”, is snake oil hooey.” Just as helmet manufacturers all want a label from the Snell Memorial Foundation on their product, motor manufacturers want a high score in the NCAP crash tests, hotels want 3 stars from The AA, HiFi manufacturers want a good review in WhatHifi? and caravan sites want a star from Practical Caravanning, why wouldn’t civil, independent, drugs testing and knowledge happen and make its findings available, if doesn’t already?
Finally, what company wants its customers killed off? That doesn’t sound like a sustainable business model to me?
Mark Holland said:
“Finally, what company wants its customers killed off? That doesn’t sound like a sustainable business model to me?”
Yeah, it’s been a disaster for BAT, hasn’t it?
Oh well in that case I have no qualms about travelling to Benidorm on the astoundingly cheap EasyZeppelin. :cool:
Oh, Damian. You are not seriously saying that tobacco companies want to kill their customers, are you?
I will reserve my response to such nonsense until you’ve confirmed that you’re actually saying what you just said. (I feel like Paxman during his Ann Coulter interview…)
Read back through my comments and note that at all times I have been conspicuously careful not to ascribe any malice to the actions of drug companies—my argument stands without any requirement for ill will on anyone’s part.
My point in citing BAT was to point up the logical error in Mark’s response. He moves from my saying “company’s action shown to be fatal to customers” to imply that I had said “company wants customers dead”. I didn’t. And I don’t have to show that to be the case to in order to make my case against drug advertising. You’re dealing with an ex-scientist here, not some tree-dwelling anti-globalization loon.
Damian, I’ll step in for Mark and say: You have completely misread his comment, though I don’t think you’re being deliberately obtuse. He was merely pointing out that it is bad business to kill your customers, and he is correct. I’m sure BAT would love it if their product didn’t contribute to their customers’ deaths; if you want to pretend any of us needs qualifications to take part in this conversation, let me point out my marketing credentials (such as they are, and such as I am sheepish about them) and say that any company would prefer a lifelong customer whose life lasts a long time than one whose does not.
You simply haven’t made your case against drug advertising, I’m afraid - or at least not one that stands a Magnum’s chance in Hades of persuading anyone who believes that legislating for the world’s stupidest common denominator is dangerous, ludicrous, and immoral. (That would be me.)
I brought up status as an ex-scientist not to claim that I am speaking from authority but to identify the culture of argumentation to which I am loyal—by comparison with that of some partisan looney “Lefties”. My being an *ex*-scientist does, if anything, undermine my qualification to speak as an expert. If you visit my CV online you’ll notice I devote most of its introduction to telling people that I am *not* an expert. I’m somewhat offended that you’d even imagine I am the sort of person to wave my qualifications around in debate in that way.
You can assert that I haven’t made my case, but it doesn’t make it true. Besides, this case is not for me to make. DTC advertising is the exception, not the rule, on this planet and the majority of people living here are happy with it that way. It’s for you to show that permitting it would have benefits that outweigh the costs. Worse for you, most people don’t share even your fundamental *priorities*, which I finally forced you to admit above, and upon which your case rests, so you have to persuade people of your premisses even before you get to your conclusions. Good luck.
No private person in England and Wales is prevented from saying anything he or she wants about any drug (within the usual legal limits that pertain to all free speech). You are calling for a widening of *corporate* rights, not individual ones, and you are attempting to smuggle it under cover of “freedom of speech”.
I distrust all corporate entities by default: whether their sponsors are the state or big business. It don’t distrust them because they are inherently bad; I distrust them because they have power and money and they exist to seek more of the same, and have a long documented history of obtaining these at the expense of those who are not their members, especially private individuals.
And I don’t advocate their restraint in this case because I distrust them in general; I advocate it here because this is a matter of life and death and the lives at risk of death are not those of the corporate entities, but those of the less well-informed private individuals who are their customers. They are less well-informed, even when they are not actively stupid, because the drug companies will always have more information about their products than their customers and the drug companies will always have strong financial incentives to keep things that way.
And if you’re looking for documented evidence of existing deceit and corruption in drug company marketing in Europe then you could start here:
http://news.bbc.co.uk/1/hi/5116312.stm?ls
I don’t take all of this report’s conclusion at face value, but I suspect that if its claims about the drug companies it cites were untrue, the writs would be flying already. That’s one of those restraints on free speech that we have agreed on as a society.
Damian, a few things:
1) Please don’t be offended.
2) I do not care one jot what is popular or what ‘everybody else’ thinks or wants. I care about what is right. Your mileage may, and obviously does, vary.
3) You should know from our dinner conversation last week that I don’t need any persuading that drug companies do shitty, immoral things. I mean, yeesh, I think I’ve even posted several times on this blog about how disgusting it is that big business acts as an extension of the state to serve its needs, and drug companies are a big part of that. (As Antoine pointed out in his presentation, pharma companies are quite happy with much of this regulation being in place.)
4) You can type as many words here as you like, but while you still believe in legislating for the world’s least sensible, you will not make any case that will persuade me. You and I value different things, which is fine (except for the bit where it makes you want to choke freedom ;-)).
[Mark (Bachelor of Science!)] moves from my saying “company’s action shown to be fatal to customers” to imply that I had said “company wants customers dead”.
I didn’t imply that at all. Jackie read it right. No biggie though, it’s not easy to sense the tone in these sorts of text based conversations.
It took a friend to diagnose me with ADHD (seven years ago).Went to a shrink, who seconded the friend’s diagnosis (although he didn’t know it was a friend’s diagnosis), and he put me on Ritalin. Changed my life. I call Ritalin my concentration vitamins. And I’m all for “better living through chemistry.”
Most hilariously (although it could have been quite unhilarious had I not simply laughed at the suggestion), I first went to a shrink when I lived in New York. I was was unhappy because I wasn’t making very much money and I wanted a boyfriend and I wondered if there was some flaw in my thinking that was keeping me down. The guy listened to me and wanted to put me on…LITHIUM!
HELLLOO? I was poor and lonely. It’s not a psychiatric disorder. I made more money and found a boytoy. Problem solved! And no crazy pills!
[…] Welsh non-dragon Suw Charman doesn’t write very often, but she’s interesting when she does and she fought my corner against ruthless streetcorner pushers Antoine and Jackie in the 2006 drug wars. Now she’s joined the other newcomers on my blogroll. […]