Advertising Controlled Substances

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, has just started a blog. I’m impressed and, given my interest in health technology, I didn’t hesitate long to add this blog to my newsreader. This should be fascinating. That said, my first comment is a bit tangential to Paul’s post regarding a Medtronic ad and its effectiveness. Paul says, in passing:

First, I am a capitalist, and I believe that firms and hospitals and others have a right to advertise, subject to normal societal rules about content and accuracy. So, you won’t find me saying that ads of this sort are immoral or unethical — although I truly understand why some people believe that.

This really doesn’t make sense to me. Ads for controlled substances are extremely hypocritical. On the one hand, we’re saying “some substances are too dangerous to be sold in a free market,” while on the other hand we’re saying “drugs should be advertised like any other product in a capitalist economy.” No, sorry, we already agreed that these were controlled substances that an average consumer can’t deal with independently. Heck, we don’t even let doctors prescribe many of these drugs to themselves! The hypocrisy reaches a truly absurd level in those paper-based ads, where there’s usually two full pages of tiny print that follow any single marketing page. Are we really expecting people to read this level of detail? Is this anything but a CYA tactic for the FDA and the drug companies?

So the typical counter-argument is: “well, often doctors don’t know about these new drugs, and patients ask them about the drugs when they hear about them on TV, then doctors look them up and a patient gets the treatment she needs.” Uhuh. What really happens is that a doctor often doesn’t have time to read up on all the latest drugs, the patient keeps bothering the doctor about this wonderful drug advertised on TV with all the typical excesses of advertising, and the doctor will then tend to prescribe the drug a bit more than she would if she weren’t pressured. The doctor’s not doing this entirely consciously, she’s not evil, it’s just the normal human reaction when the patient wants something. This is purely about tipping the scales to increase consumption. It’s advertising. Of a controlled substance. And, as a result, doctors take more risk on average than they would otherwise.

So I’m a capitalist. I believe the government should intervene in limited ways to ensure continued competition (because a free market doesn’t stay free on its own), to attempt to give everyone the same chance at success (education, health care, etc…), and to protect people from things they would be hard-pressed to understand on their own (lead paint, prescription drugs). If we can’t advertise alcohol and cigarettes on TV, then why are we advertising anti-depressants? Is it not clear that this has far more potential for harm than for good?

In a later post, my thoughts on who’s responsible for this. It’s not the drug companies: they are, like any other company, working to make a buck, and I expect them to do what’s in their best interest every time, just like any other company. The problem is with the FDA.

UPDATE: fixed the spelling of Medtronic, thanks Motty.