McKinsey Advised Johnson and Johnson on Increasing Opioid Sales (opens in new tab)

This is already the case in many places outside the USA (Canada, Europe, Brazil, Hong Kong).

https://en.wikipedia.org/wiki/Direct-to-consumer_advertising

Do you prefer Instagram "influencers" to have more control over what drugs people take than the current regulated advertising? I don't.

And there is plenty of research demonstrating that this is exactly what they do, and that doctors are indeed swayed by it, because, as you say, they don't have the time to do keep up with it all on their own.

And yes, there is a fundamental difference to consider here: My doctor has a fiduciary responsibility to do what's best for my health, to the best of their ability, and drug marketing compromises that. By contrast, nobody has any fiduciary responsibilities related to which brand of toilet paper I use.

Look at car ads. Do they say "The new 2019 models are available"? A few do. Do they say "This car gets better gas mileage" or "This car is safer"? A few do. Most say "If you drive this car, you'll get the hot girl". That's not "educating consumers". That's trying to make consumers want your product on the basis of something completely unrelated to your product.

And yes, I fear that marketing pharmaceuticals may in fact not be different from marketing any other product.

As an aside, it's insulting to preface a rebuttal with, "this may come as a shock to you".

I do agree with you that pharmaceutical marketing isn’t fundamentally different from marketing other products. Although my conclusion from that is not that pharmaceutical marketing is therefore good.

I often ask foreign expats in America about the strangest aspect of American culture in their opinion. Believe it or not, pharmaceutical advertising is one of the most common answers I get.

That's how it is, in practice.

But some of us take that Hippocratic Oath thing seriously.

A lot of marketing does not seem very educational and more manipulative.

Most advertising is more about triggering emotions and using other cognitive dark patterns than educating anyone.

Really? You don't see the difference between marketing, say, a car or a smartphone, and marketing a drug that treats a life-threatening condition?

Perhaps you should think about this subject a bit more deeply.

>> I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs.

What do you base this on? Do you have some citations to support it?

It's important to realize that to a first approximation, advertising prescription drugs is pure waste. The main case is pharma companies battling for fixed market share. That is, there are N people who have the problem, and companies X, Y, and Z are spending money trying to maximize their share of the market. The ad spend changes which pharma company does the best, but that money comes from the sick people, who would be better off without it.

The other case for advertising is demand generation, and for drugs I think it's mostly waste as well. I definitely know a couple people who are not sick enough to really need drugs (or perhaps not sick at all), but advertising-induced hypochondria means they badger their doctor until they get a prescription. That's an expensive boondoggle.

I'm sure there are some people who hear an ad and realize they have an actual problem. But if that's a significant issue, I'd rather we just paid for public service announcements for disease awareness, rather than hoping the very profitable drugs are the same ones people have the biggest medical need for.

And theory aside, advertising prescription drugs to the public was illegal for decades and we still did fine on the medical innovation front.

Doctors/hospitals can learn about new drugs through dry, informative leaflets - TV ads or salesmen talking directly to doctors distorts the demand.

There is moral validity to profit-seeking investment in drug trials which find effective treatments, but the current system enables this only with great amounts of inefficiency.

What the current system gives us isn't "R&D and innovation". It's mostly ~equivalents of top-selling products. Plus new stuff that's actually less effective than old products that went generic so long ago that there's ~no promotion.

we're gonna pay for the drugs either way, so we may as well create our own incentive structures to ensure that it's done right.

Well, there's disease, death, suffering and injury. If you need more of a structured incentive than that, then I am not sure really what to suggest.

A patient that walks into a doctor's office asking for a certain medicine they heard about on TV distorts the process. After all the patient needs to believe in the treatment and might shop around for the doctor that gives them what they want.

Learning about a product in a medical context can't really happen in an ad. A doctor would have to go to a conference or read journals to figure out the latest science on treatments, and can then go and then choose an appropriate drug. They would probably look for the one that has 20mg of X in it, regardless of brand name or hype.

People need agency in their own medical choices, and knowing there is a drug for your medical condition is very empowering. Especially as we talk more and more about moving to a single-payer system, it's important to make sure patients have the power to question their doctors and explore their own health instead of essentially being dictated to by the state.

Find a natural experiment where two very similar populations, chosen at random, were placed into two different cohorts. I'm sure there's one somewhere in the recent and well documented past.

Yeah, there seems to be this contradiction here that doctors are naive or corrupt and are going to be swayed into prescribing us drugs we don't need, but also that we should be leaving it 100% up to doctors to be informed and prescribe us what we need.

or possibly just delivering takeout to them at the hospital so they can relax and research new treatments while eating.

(seriously, drug companies give doctors free takeout)

- Supply your molecule for free to all researchers without any strings attached.

- Maintain an inclusive directory of research people have performed with your molecule. Publish a journal of all research and redistribute it for free.

- Commission impartial fact sheets that are surveys of treatments for a given condition - what objective measures of outcomes can be made between treatments, both positive and negative?

Management consultants nearly always have a conflict of interest though (i.e. the preoccupation of consultants is almost always "sell, sell, sell" rather than "help the client make money") due to the nature of their work and their short-term contact-based engagements mean they rarely have to stick around and deal with the messes that they create.

Large management consulting firms IME tend to hire (or develop maybe) people who are smart and ambitious but highly conformist and reluctant to challenge authority. Combined with nature of the work I described above (and ofc existing to make owners /partners rich), this is sort of a perfect storm for lots of "semi-unintentional" unethical behavior and sometimes fully intentional unethical behavior.

Fwiw, from what I observed this dynamic actually makes the consulting work environment terribly exploitative and miserable for non-partner consultants but consultants tend not be the personality types who would leave consulting (and the prestige/"potential to become a partner") over it --unsurprisingly, else the industry wouldn't exist as it does now.

No. This is very mistaken. There are many more stakeholders that companies have than their owners. For example, their customers. For example. Private Hospitals do not exist to make money. They can make money. But they exist to provide healthcare to sick people. As a side effect they pay their employees and make money for their owners; but if they fail to provide healthcare then they cease to exist. On the other hand, if they fail to make money they are often taken over and continue with new owners.

Companies exist to serve a function in our society, they depend on our society and they are part of it. They are not cash machines.

All companies exist to provide profits to their owners.

Overly simplistic.

Not all companies exist to provide profits to their owners. There are thousands of companies in the U.S. and elsewhere which exist for other reasons.

We were just coming out of another era where opioids were restricted to the inhumane point where people with serious problems were left in debilitating pain - to the point where Purdue's lies were accepted because doctors felt genuine sympathy towards the suffering they saw.

There is a happy middle ground. There are people who benefit from opioid medications.

It was bad moral choices by this generation's pharmaceutical companies that caused this outbreak. That is where the fault lies.