Why is Frist against DTC ads?

Bill Frist is adding a new and unexpected theme in his bid for moderate cred--hostility towards direct to consumer (DTC) drug ads:

The guidelines closely followed a US Senate floor speech by Majority Leader Bill Frist, Republican of Tennessee, who derided such advertising, saying it drives a wedge between doctors and patients and increases prescription drug costs. Frist called on the industry to voluntarily ban advertising in the first two years new drugs are sold.

If the voluntary restrictions don't work, Congress should step in, Frist told Senate colleagues. [BGlobe]

Strategically, this is a good issue for Frist. He's trying to revive his image as strict father/wise doctor. Threatening to regulate DTC ads is an empty but reassuringly paternalistic gesture. "The good doctor is standing with science and professionalism against the vulgar forces of commercialism."

Moderates may be impressed that Frist is willing to entertain the federal regulation of anything besides women's bodies. Restricting DTC as would probably be a good idea. I doubt it will do much to decrease drug costs, though. If DTC adds were banned,the pharmaceutical companies would immediately redirect their DTC budgets to physician-oriented promotions.

Frist is clearly on the outs with the wingnuts. He isn't even invited to Justice Sunday II. John Aravosis and Atrios take this estrangement as a signal that Frist's fortunes are dimming within the Republican party.

I wonder who dumbed whom, though. Did the Terri Schiavo debacle seal Frist's fate with the theocons? Or is Frist deliberately severing his ties to the snakehandling wing of the party? His reversal on stem cells suggests that he had already written off the rapture right as a political liability. Frist's defection may say more about the political fortunes of movement conservatism than about Frist's own prospects.

Comments

[Alon Levy]

Restricting DTC as would probably be a good idea. I doubt it will do much to decrease drug costs, though. If DTC adds were banned,the pharmaceutical companies would immediately redirect their DTC budgets to physician-oriented promotions.

Actually, curtailing DTC advertising would make consumers switch from prescription drugs to OTC drugs, which to my knowledge cost less. The only reason big pharma engages in DTC is because it increases its revenues, which presumably means consumers are getting drugs they don't need or buying prescription drugs when OTC ones will do just as well. Furthermore, even without such a switch, big pharma already advertises to doctors, so there's not much room for increasing costs here. Moreover, DTC advertising is in general misleading, because for obvious reasons it fails to inform consumers about better alternatives, such as OTC drugs or homemade solutions.

On the other hand, DTC advertising is a drop in the bucket that is American spending on health care. I read somewhere that big pharma spends 2-3 billion dollars every year on DTC advertising. The United States wastes 700 billion dollars every year on health care. Curtailing DTC advertising is good as a measure of protecting the consumer, but it won't make a dent in American health care costs.

[Lindsay Beyerstein]

A real ban on DTC might make the public more willing to shift from brand name to generic drugs. I favor such a ban for exactly that reason. However, I think that banning DTC without regulating promotional spending in other channels probably wouldn't have that much of an impact on drug spending. The ban would just free up money to lean harder on doctors.

I don't think Frist is serious about banning DTC. He's proposing voluntary restrictions on drug promotions for the first two years post-launch.

[Alon Levy]

However, I think that banning DTC without regulating promotional spending in other channels probably wouldn't have that much of an impact on drug spending.

What other major promotional channels are there, apart from pressuring doctors to prescribe the company's patented drugs?

I don't think Frist is serious about banning DTC. He's proposing voluntary restrictions on drug promotions for the first two years post-launch.

What's exactly a voluntary restriction? Is it like Frist's "You Democrats can keep the filibuster as long as you don't use it," like the DNC's "Stop confirming Bush's appointees or we'll say stop again," or something in between?

[Barbara]

DTC ads not only increase the use of brand over generics, they increase the use of the advertised drugs, period. Doctors will tell you of patients who demand a drug that they have seen advertised even when they don't know what it's for. This is still most likely a small percentage of the overall health budget, of course, but it does have a real effect. Also, most DTC drugs don't have generic equivalents, BUT some of the non-advertised alternative brands do have generic equivlents.

As for how pharmaceutical manufacturers increase the utilization of their drugs other than through direct physician marketing, you can start wtih one of the most pernicious practices: financing "research" of the product's benefit for off-label uses and then creating a marketing "buzz" by leverageing that research for presentations at seminars, conferences, and so on.

Also, by influencing researchers who are supposed to be independent to "dumb down" the definition of diseases so that more people are considered to be in need of specific pharmacologic interventions. The Seattle paper (can't remember which one) had a great series on this practice. Cholesterol lowering drugs are the poster child of this tactic.

[Eli (creepandblink)]

Frist has belonged to the McHospital lobby long before he belonged to the theos. Creating more people who come to the doctor with a set idea of which prescription they want eliminates a lot of the profit benefits of strategic prescribing and the pharm-rep relationships they create. I wonder if that's a factor.

[Barbara]

Honestly, Eli, I think that doctors just find it annoying to be pushed around by patients. At least the phenomenon of patients seeking this or that drug has been communicated to me as if this is the problem. Doctors also hate it when their patients come in armed with web site print outs but I don't guess that anyone could reasonably call for the elimination of health related internet sites.

[Eli (creepandblink)]

I'm sure that annoys doctors. You're probably in a position to know more than I do what Joe and Jane Medical Professional think. I'm not sure, though, that Frist is particularly interested in pursuing the goodwill of the medical profession for its own sake (though he may be, fearing some kind of backlash if he tries to highlight it in '08). I'm not in any way trying to impugn the motivations of doctors in general, but if my family fortune was tied up with HCA, the way the Frists' always has been, I'd be concerned with their profit margins. And the pharm rep relationship can be a good bottom-line-serving one for hospitals, right? Maybe I'm completely wrong about that. But if it is a beneficial relationship, I can see how there might be fear that DTC ads could bypass the hospital-courting a bit.

[Alon Levy]

Well, if DTC ads weren't good for big pharma, they wouldn't exist, right?

[Eli (creepandblink)]

Oh, no doubt they're good for big pharma. But a huge part of how they might be good for big pharma is that they let them buy popularity directly through patients, reducing the degree to which they need to woo doctors, hospitals, and big hospital chains. So they may be at least a little bad for the chain hospital industry, where the House of Frist gets its bread and butter.

[Amanda]

With Frist's move to center, we can't discount human reasons completely. He did practice medicine for a long, long time. He may very well be unable to bring himself to destroy his reputation as a doctor for a single day longer. Didn't he go into politics because of some issue with his practice? I've known plenty of doctors who are conservative on practically every issue except those that they know about through their practice, such as abortion, where most doctors of any political bent are pro-choice.

[mudkitty]

Oh Amanda...Amanda, Amanda, Amanda.

[Thad]

With Frist's move to center, we can't discount human reasons completely.

If Frist were in fact human, and not in fact a relentless kitty-killing machine from the future, I'd be inclined to agree.

[Alon Levy]

So he killed cats. How is that relevant to why he supports tighter regulations on DTC advertising?

[Barbara]

Doctors stick together pretty well when it comes to anything that threatens their independence. Obviously, I don't know Frist personally, but narcissistic professional self-protection is a powerful force and is the most logical explanation. Plus it looks good and consumer friendly.

Re HCA: Hospitals are in a somewhat different position from doctors. I won't go into the details, but hospitals are much less subject to the marketing forces of the pharmaceutical industry than doctors are because hospitals actually have to buy the drugs that they dispense and are extremely conscious, for instance, that certain brand name drugs have generic equivalents and otherse don't. Doctors prescribe but never have to foot the bill for their decisions. Also, most of the drugs that are advertised are clearly outpatient drugs that would not consume much of a hospital's pharmaceutical budget. So I would discount Frist's personal financial stake in this matter.

[Eli (creepandblink)]

Barbara: Thanks for the clarification on the hospital economics - I'm certainly no expert.

I think the best explanation is probably that Frist loves to play the doctor card politically - always has. And it behooves him to get his med cred up before '08 and a possible OR Veterans for Truth debacle.

[Njorl]

I think it demonstrates Frist's realization that he is not going to be the next president. He wants to stay majority leader. The 2006 elections will see many republican senators distancing themselves from Bush, and Frist wants their support in the senate.