when pigs can fly…

Posted on Wednesday 30 December 2015

By Ed Silverman
December 30, 2015

In a controversial move, the American Medical Association recently called for a ban on advertising prescription drugs and medical devices directly to consumers. The effort is largely symbolic because any ban would have to be authorized by Congress. But doctors resent the increasing pressure the ads place on them to write prescriptions out of concern patients will switch physicians. And they argue that many ads aimed at consumers promote more expensive medicines. Richard Meyer, a former Eli Lilly marketing executive, who is now an industry consultant who runs the World of DTC Marketing blog, explains why he believes the AMA is misguided.
the Restasis® Cyborg
By Richard Meyer, pharmaceutical consultant

Last month, members of the American Medical Association declared that drug makers should stop advertising their products directly to consumers because they feel it contributes to an increase in health care costs and pushes patients to ask for products that either they may not need or is not right for them.  This approach is, at best, misguided, and, at worst, ignores the benefits of direct-to-consumer advertising for patients. According to a study on DTC marketing that was conducted by Eli Lilly, 25 percent of patients who were prompted to visit their doctor after seeing an ad were given a new diagnosis. Of those patients, 43 percent were a “high priority” diagnosis for a serious health condition, like diabetes or hypertension. That same study indicated that 53 percent of physicians felt that DTC ads lead to better discussions with patients because patients are better educated and informed. In addition, a 2004 Food and Drug Administration survey of physicians and patients found that exposure to DTC ads spurred 27 percent of Americans to make an appointment with their doctor to talk about a condition they had not previously discussed. Another study found that the small print in a drug ad was strongly associated with patients contacting their health care providers.

But there is more.

A November 2006 report from the General Accountability Office noted that only 2 percent to 7 percent of patients who requested a drug in response to a drug ad ultimately received a prescription for the medicine. In another study, DTC ads increased the likelihood that a patient would initiate a dialogue with a physician to request an advertised drug. In still another study, which was conducted in 2010 by Prevention magazine, 79 percent of those queried said they sought a specific product. At that point, the magazine had tracked such data for 13 years and the figure was an all-time high. Yet, only 19 percent of the patients actually received the product they sought, an all-time low. DTC advertising increases awareness of health problems and leads to a better informed and educated patient who can engage their physician in a dialogue rather than a monologue.

So what’s really going on here?

First, insurers are taking more prescription writing power away from doctors.  They first want patients to try generic medications which now make up 88 percent of all available prescription drugs. Second, higher patient copayments for office visits and insurance mean consumers are “shopping” for health care and health care treatments. This makes doctors very uncomfortable. Even with all these changes, research continually validates the notion that patients view their doctors as the gatekeepers to their prescription medicines. If a doctor doesn’t feel it’s right for the patient, then they won’t write for it.

The AMA would be better served to remind doctors to have the so-called “weight” conversation with patients, since obesity is at epidemic levels here in the United States and is costing health care billions of dollars. Patients should be warned of potential problems, if any, and, in conjunction with insurers, a comprehensive wellness plan should be developed. DTC advertising leads patients to their health care providers and, depending on the health condition, does not lead to high-priced unnecessary scripts. The AMA should reach out and work with pharma to improve DTC marketing, not request a ban on all DTC ads.
I only posted this absurd bit of spin as an example of how dumb the ad-men must think doctors are – and I haven’t been able to use my when-pigs-can-fly graphics for a while [I can’t find my lipstick-on-a-pig graphic]. For more BS, visit the World of DTC Marketing blog…

UPDATE: Saved by a friend!
    December 31, 2015 | 9:35 AM

    A better image would have been a snake oil salesman with bunch of dead people laying around him.

    James O'Brien, M.D.
    December 31, 2015 | 11:31 AM

    I find the marketing behavior of the nutritional supplement companies to be a far bigger problem. At least the drug companies have done research we can debate as opposed to no research and pharma is under strict regulation already about what they can claim as a benefit. Thanks to an odd consortium of granolahead entrepreneurs and owned political hacks like Orrin Hatch, supplement companies get away with outright fraud all the time. 98% of the products in a supplement store are placebo, you can’t say that about a pharmacy. Supplements are chemicals the public consumes, I don’t know why they should be under such a lax standard while pharma gets all the heat.

    December 31, 2015 | 3:34 PM

    Eureka! The solution to all medical problems in the United States is to strap our citizens down with Lovely Ludwig Van playing in the background while watching an endless stream of DTC drug ads! Why didn’t anyone think of this before?


    I do like James’s point. But, if nothing else, at least placebo tends to be relatively harmless (in itself, there is the problem of substituting for something that might work).

    December 31, 2015 | 9:33 PM

    I would love to see a link to research supporting Dr. O’Brien’s point that 98% of all supplements are the placebo effect. Interestingly, on Altostrata’s Surviving Antidepressants site, people are cautioned to be very careful when taking supplements because many folks have reported that they aggravate withdrawal symptoms. Definitely not the placebo effect since people weren’t expecting to have these reactions.

    Pat Carroll, I have had experiences where supplements did a much better job than a prescription drug I was given in accomplishing the same purpose. You sound like you are unintentionally succumbing to a general physician bias that drugs are good and supplements are bad.

    It just seems like there is no middle ground in the medical community regarding this issue. Many of the alternative folks think that supplements are harmless which isn’t accurate and many physicians think they are all bad which also isn’t right. That doesn’t serve the patient well at all.

    January 1, 2016 | 1:02 AM

    Love the pigs.

    James O'Brien, M.D.
    January 1, 2016 | 11:26 AM


    And you can find hundreds of similar articles with a simple Google search.

    Unlike pharma, there is no requirement to prove efficacy, poor quality control in manufacturing, and underreported safety issues. These companies can just about claim anything they want.

    Many of them are also multilevel marketing scams.


    Just because an entrepreneur looks more like Crosby Stills Nash or Young than a tobacco executive doesn’t mean he or she is to trusted.

    I said most, not all. If I didn’t I would be a hypocrite as a consumer of fish oil (be very careful on quality and ingredients, most are worthless) and CoQ10.

    January 1, 2016 | 12:51 PM


    “Is Dr. Stephen Barrett fair in his analysis of nutrition research and those involved in the nutrition industry?
    I have not read every single page on Quackwatch and I do not read most of the new pages that are added on the site, but the ones I read give me the impression that in many cases he has done good research on many of the people involved in the alternative health industry, and has pointed out several instances of inaccuracies and scams (for instance, Hulda Clark and her pitiful book “The Cure for all Cancers”). However, I hardly came across reports on his website regarding some of the scams or inaccurate promotion and marketing practices by the pharmaceutical industry. Why is this? Why has Stephen Barrett, M.D. focused almost all of his attention on the nutritional industry and has hardly spent time pointing out the billions of dollars wasted each year by consumers on certain prescription and non-prescription pharmaceutical drugs? If he truly claims to be a true consumer advocate, isn’t it his responsibility to make sure the big scams are addressed first before focusing on the smaller scams? It’s like the government putting all of its efforts going after the poor misusing food stamps while certain big companies cheat billions of dollars from consumers with hardly any governmental oversight.
    Why is there no review of Vioxx on Quackwatch? Why is there no mention on quackwatch.org of the worthless cold and cough medicines sold by pharmaceutical companies and drug stores? Hundreds of millions of dollars are wasted each year by consumers on these worthless and potentially harmful decongestants and cough syrups. Why is there no mention on quackwatch of the dangers of acetaminophen use, including liver damage? There are probably more people who are injured or die from over the counter Tylenol and aspirin use each year than from all the natural supplements people take throughout a year. If Dr. Barrett had focused his career on educating people in reducing the use of useless and dangerous prescription and nonprescription drugs (even just one, acetaminophen) he would have helped many more people than attempting to scare people from the use of supplements.
    Another point I would like to make regarding Quackwatch is that Dr. Barrett often, if not the majority of the time, seems to point out the negative outcome of studies with supplements (you can sense his glee and relish when he points out these negative outcomes), and rarely mentions the benefits they provide. A true scientist takes a fair approach, and I don’t see this in my review of the Quackwatch website. I subscribe to the Quackwatch newsletter (which often has interesting information) but there is hardly any mention of the benefits of supplements. As an example, see a paragraph from the August, 2006 Quackwatch newsletter mentioned a few paragraphs below.
    Bottom line: Overall, Dr. Barrett does some good in pointing out scams in the alternative health field, but, in my opinion, he is not fair and balanced, and he is not a true objective scientist as he claims to be. Someone who has a website specifically tailored for criticism needs to have a higher and more objective scientific standard, and Barrett fails in this regard.”

    Regarding the other link you provided, not exactly links to pub med studies but more like propaganda pieces against supplements. Studies are quoted but as you very well know Dr. O’Brien, many times what is reported by the media isn’t exactly in the study.

    And again, I am not making these points as fans of supplements. I do agree you have to be very cautious. I am just tired of extreme biases in the medical industry.

    You do know many of your colleagues feel fish oil is worthless, right? How come you’re not listening to them? I am being half facetious as I feel I definitely benefit from it although I have to be very cautious on the dosage due to my hypersensitivity issues.

    Yeah, I could have done one of those “simple google” searches but I feel when someone makes a statement like you did about supplements, I don’t think it is unreasonable of me to ask for proof which I feel you didn’t provide. I am sure you will disagree.


    January 1, 2016 | 2:08 PM

    Am I the only one who remembers about, what, 15 years ago that St John’s Wort was going to transform the treatment of depression?

    I do laugh out loud typing this, a three times a day drug, that had as many side effects as potential benefits.

    I’d provide the perfect image for this tomfoolery, but, Mickey does not want that.

    I have it at the end of my last post from yesterday, quite accurate for what snake oil salesmen really are about, hmm?

    James O'Brien, M.D.
    January 1, 2016 | 11:25 PM

    You seem to have seem preexistent issues with Dr. Barrett which are tangential to the topic here. You’ll have to take them up with him since I am not his spokesman.

    In any case, I find it difficult to take pharma criticism seriously when one is inclined to take supplement claims seriously. It’s this bizarre mentality of judgment that nihilists don’t have to be accountable because they have no ethos whereas the people who claim a code and sometimes don’t live up to it are somehow worse.


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