Failure to Communicate

Quick: turn on the TV (no, streaming doesn't count!).  You won't have to wait too long before an ad for some prescription drug comes on.  Watch long enough and pretty soon you'll suspect that you have a variety of conditions that you may have never realized before and need to do something about immediately.  Fortunately for you, of course, the pharmaceutical industry has solutions for you.  It's all there in those ads.

Whether we really understand them or not is another question.

Direct-to-consumer (DTC) ads for prescription drugs are booming.  After a brief respite during the most recent recession, they're back up, with spending estimated at some $5.2b in 2015 (amazingly, the DTC ads are less than 20% of pharma's overall marketing budget, with the majority of that going to face-to-face "educational" efforts with physicians).

NATALIA BRONSHTEIN/STAT

DTC ads have been controversial since they were first allowed in the 1980's (although broadcast ads didn't really take off until 1997, due to more relaxed regulations).  Indeed, New Zealand is the only other country that allows them, and the AMA has called for a ban on them in the U.S.  There's a concern that, well, the ads work -- the pharmaceutical companies persuade consumers to want their drugs, whether or not they are more effective or cheaper than existing options.

New research from market intelligence firm InCrowd helps illustrate the problem.   They surveyed physicians about DTC ads, and found that they get three times as many questions about them as they did five years ago (although I was shocked that they report only six such questions a week).

Unfortunately, 65% say they do not believe their patients understood the information in the ads.  Only 13% of physicians thought that most of their patients could understand/interpret the ads, 43% thought that maybe at least some of them could, and the rest thought that few or none of their patients could.

Equally important, physicians do not believe the ads help.  In fact, almost half felt that they actually impair patients' understanding of their conditions or treatments:

Not surprisingly, 35% of the physicians would ban DTC ads entirely, while 31% want to at least provide additional patient information, and 17% call for simplifying the message.  

As evidence of the lack of understanding, a study in Annals of Family Practice found "substantial discordance between patient and physician evaluations of drug adherence and drug importance."  Nearly 20% of drugs considered important by physicians were not taken correctly by patients, and nearly half of that non-adherence was intentional. 

I guess the ads weren't quite enough.

This is serious stuff.  Harvard professor Donald Light points out that:

• New prescription drugs have a 1 in 5 chance of causing serious reactions even after they get FDA approval;
• Reactions from "properly" prescribed prescription drugs (e.g., for intended uses) cause some 1.9 million hospitalizations annually, with another 840,000 hospitalizations coming from other adverse drug reactions.  
• There are some 81 million adverse reactions suffered annually by the 170 million Americans taking prescription drugs.
• 128,000 people die annually die from reactions to prescription drugs, tying it for the 4th highest cause of death.
• At most only 15% of new drugs offer significant clinical advantages over existing drugs.

You don't really get any of that from those (fine print) side effect warnings, do you?

Let's be fair about the problem, though.  We can't put the blame on the pharmaceutical companies, at least not entirely.  We just don't understand our health care generally.  The Institute of Medicine estimates that nearly half of adults have trouble understanding what their doctor is telling them about their conditions and treatments.  Most patients discharged from the hospital don't understand their discharge instructions.  

The National Assessment of Adult Literacy found only 12% of us have "proficient" health literacy.  Low health literacy is associated with a host of health woes, including less use of preventive services, more chronic conditions, lower health status, and higher spending.  

No wonder we want to take action when we see those DTC ads, even if that may just compound our problem.

Part of the literacy problem is a societal one.  According to the Literacy Project Foundation, 50% of us can't read a book at a eighth grade level (which may help explain why 44% of adults have not read a book in the last year).  Forty-five million Americans are functionally illiterate and read below a 5th grade level.  Blame it on the schools, blame it on the parents, blame it on our culture, but wherever the blame lies, it makes communicating any complex issue difficult.

But much of the health literacy problem is health care specific.  Every industry has its own jargon, but few of them use the jargon with the consumers to whom they sell.   Names for drugs, conditions, treatments, even insurance features -- these are not ones that are easy for consumers to understand, remember, and make decisions about.  Health care is designed around health care professionals dealing with other health care professionals, not consumers, and its language reflects that.

In the unforgettable words of the sadistic warden in Cool Hand Luke, "What we have here is, failure to communicate.

Moreover, health care is notoriously imprecise -- try asking your doctor for the effectiveness statistics of a proposed treatment or prescription.  The statistics may not exist at all, may be contradicted by other statistics, or your physician may not know them or be able to communicate them to you.  It's hard to make good decisions with bad facts.

So, yes, DTC prescription drugs ads may be confusing, even misleading but, honestly, I have more trouble with how pharmaceutical drug companies try to influence physicians than with how they try to influence us.  

I'll own my bad decisions if I at least get unbiased advice, and with many aspects of health care I'm not always sure I am, given hidden financial incentives (e.g., prescription drug rebates, or payments by pharma/medical device companies to physicians) and the that's-how-we-do-it-here syndrome.  

We can do better.  Start with simpler language -- not talking to us like we're dumb but talking to us like it is important we actually understand -- and back it up with facts instead of marketing promises.  

That's an ad I would watch, or advice I would take.