Hey Charles–

MRE

But Mike, some of the angst I’m reading here is just a little skewed. Not all generics ARE created equal. Not all new drugs have a counterpart–yet. And pretty much no ad, good or bad, was created by the company who made the drug.

‘Any medication you see advertised on television has a less expensive counterpart out there’ is not always quite the case. There may be a similar drug out there…and there may NOT be, yet. NDAs (new drug applications) are for a drug which somehow, some way, differs in mechanism of action or effect or is tolerable to different conditions or effective in lower or less frequent doses. There has to actually be a difference for it to qualify as an NDA, and get approved. Sometimes, that difference is the thing that makes taking that med possible for a percentage of the population. And if you really need the med, that difference can be the world.

Drug companies don’t make the ads–they buy them (or rather, the ideas for them.)
Advertising companies make the ads, and drug companies approve them–but things like Jarvik, or prostate–a growing problem or Cialis ads–they are all a creative department idea (or failing). It ain’t the science selling that stuff. It’s the people the company pays to think up a way to market it, who sell it to the suits in the front offices of the drug company’s marketing group.

Sure, there are ad and marketing types in every drug company–but they serve mainly as translators to the creatives in the outside world who speak their own language and have their own sets of three-letter-acronyms. Internal media outsources the heavy lifting of creating the campaigns to the bona fide ad agencies. I used to be one of the ad agency people who had to come up with the marketing plan packages and the slogans and then sell it to the suits from whatever company we were pitching. Bibles, durable medical equipment, insurance, industrial washing machines, charitable giving programs–describe your product and it was my job to sell it (whether I thought it was stupid or not–which is one reason I am no longer in advertising!) If the resulting ad is stupid or insulting, it’s because the drug company bought it, but not because they dreamed it up.

One very good series of pharma ads, IMO, is the one promoting pharmaceutical research and Glaxo Smith Kline. It shows researchers, and why they choose their area of research, but none of them promote a specific drug. It reminds me why I enjoyed creating the kind of advertising that makes you think (yes–there is such a thing!). And it makes me proud to have spent 14 years doing preclin R&D drug safety research, and to now be making that work possible for others. It rings true in the context of the scientists I work with, and it feels real. Hats off to the company that created that idea, and to GSK for not messing with the good idea.

The first rule of being a smart creative is to never show a client a bad idea–because even if it’s presented in the context of five or six other amazing ideas, the client will embrace the bad idea every time. EVERY time. So shame on whatever ad company thought up the idea of talking mucus to promote the decongestant Mucinex…but I can’t really blame the drug company for buying it. It’s exactly the kind of cute crap suits from stiff companies love. It was my job as a creative to make sure that kind of bad choice wasn’t even presented to them so they wouldn’t make fools of themselves. And clearly, someone in the ad agency dropped the ball the day talking mucus sounded plausible!

I really like the story of Mucinex, an over the counter expectorant/decongestant, which used to be available as the generic prescription guaifenisen and has always been available in liquid form as plain old unglamorous Robitussin expectorant cough syrup and its generic counterparts. The plain expectorant type of Mucinex, which I take daily because I live in the rain-soaked northeast (instead of somewhere like Tuscon), contains 600mg of guaifenisen–just like the old scrip stuff. The company that marketed the prescription version (which cost me about $6 for 60 tabs, versus the 50 cents per tab Mucinex costs), somehow failed to renew the right paperwork and lost the right to sell it about five years ago. Enter Mucinex, at approximately 8 times the price of the prescription drug. After about 12 months on the market, I began to see an unbranded tablet form of the drug that is relabeled and sold on the internet and in Walmart–but it’s a lower dose per tab…and the price for two tabs is just about the price for the branded med…so no payoff in going generic there. The generic is not equal to the branded product–you have to take more of it to get the same effect. And yes, in that case, the company is clearly protecting an investment in name and marketing $$$ with direct to the consumer drug costs.

But, to take this in another direction–I belong to an employer-sponsored health insurance plan. In those programs, patients frequently HAVE to purchase the generic version of a prescription. The insurance company makes that decision–not the doc, and not the patient. The insurance company can deny coverage of any price in excess of the generic’s cost, and they do. Been there, paid the bills to prove it. I’m sure you remember that little box at the bottom of a scrip pad…and the phrase ‘dispense as written if box is checked’ or something similar. The doc must specifically X that box in order for the patient to get the branded version when an exact equivalent generic is available. Otherwise, the dispensing pharmacy gives out the generic–per the insurance company branch of the healthcare industry. It would be the insurance companies and health care plans and pharmacies scoring on that one, Mike–not the docs, and not the ad agencies, and most days, not the patients, either.

One of my pharmacy benefits is that I am eligible for any med my company manufactures free of charge–if it can be dispensed by a pharmacy and self-administered. There aren’t a lot of meds my company makes that you’d WANT to be sick enough to have to take, and infusion meds don’t count. But our employee prescription benefit, regardless of the health insurance plan chosen, mandates use of a specific mail order pharmacy…and any scrip for what the plan classifies a maintenance med MUST be written for 90 days, with three 90 day renewals, and filled by mail for a preset minimum copay (which can go up if the med costs more.) If the employee chooses to use the local bricks/mortar pharmacy, all fills after the 3rd one are charged 100% to the employee at the current retail price for the drug. And the prescription benefit for drugs that can’t be filled mail order or for those first three fills while a doc is trying to figure out what med/dose works for you, is a minimum $10 copayment, or 10% of the retail cost, whichever is *greater.* If the doc does a dispense-as-written 90-day scrip and you try to fill it mail order, it will be bounced back to the doc to rewrite if a generic is available. So I can’t just go in and ask to try Ambien unless I’m willing to pay the retail cost of the drug at my local pharmacy. Trust me, THAT gets old fast.

Anti-emetic pre-meds for chemo infusions were $60 for six pills (two infusions), and the low molecular weight injectable heparin I take daily is $100/month for 30 doses (charges for needles and syringes are extra, of course.) Neither med was eligible for mail order, so I had to pay 10% of retail (since it was greater than $10.) I pay for the sharps I need for the heparin out of pocket…it’s 30 cents a setup from my local pharmacist (who thinks it’s possible I have the worst prescription benefit he’s ever seen), versus 28 cents a setup if I were to get them on a maintenance scrip from the mail order pharmacy. The group scoring on this arrangement is not the employees…it’s the mail order pharmacy and the underwriter guaranteeing the policy for the company. I don’t think the company is scoring that well, either…but they wanted to set an example as part of the pharmaceutical industry. My *mother* gets her meds cheaper than I do…and I subsidize her medicare part D plan with my taxes. When she and I are taking the same med (thankfully, that doesn’t happen often, but it did briefly with a couple meds during chemo), I was effectively paying twice…once through the nose for my meds, and once via taxes for hers.

And no, I cannot justify the prices charged at retail for new drugs…even though I do know the average time to approval (it used to be 15 years; I think certain drugs, when fast-tracked, can be brought in under 8 years) and I do know the costs associated with developing a new meds. I am one of those costs, after all (IT support, and before that, the staff that actually compounded the drugs and did the preclin testing). But that is a feedback loop that is bigger than an ad campaign that prompts a viewer to ask a doc about X medication.

I think Saturday Night Live could do a lot with that material…or any of the commercial spoof sites. But I’m not sure the drug companies are the only ones responsible for the ads. I’ve learned first hand that what insurance will approve and what they mandate about scrips plays a huge part in what a doc will write, and what a pharmacy will fill.

As always…to paraphrase Arsenio Hall, something to make me go ‘hmmm’.

Hi Gaelen–

MRE

That’s what we try to do whenever we actually watch a TV program other than football.

MRE

Thanks for the great clip.

As to the ‘Stinox’ phenomenon, I had my own misadventure with Ambien, which you can read all about in this post of MD’s.”

Ah, so you did! Sorry, I had forgotten about that – probably a bit close to home then. (BTW Stilnox (sorry about the typo) and Ambien are the same thing (Zolipidem) and from the flood of news stories here, you don’t need to be mixing up an Ambien and alcohol cocktail for either the potential embarassing or plainly dangerous side effects to ensue – eg;

http://www.theage.com.au/news/National/Lawyers-trawling-bizarre-Stilnox-reports/2007/04/02/1175366136953.html

You can just imagine how long a natural supplement would last on the market with even a fraction of these reported adverse outcomes, but drug companies seem to be judged by a different standard (or not judged at all).

As you know, I am a strong advocate for free speech but I must admit that I would find it hard to get worked up about the ban on prescription medication advertising we have in this country (ads such as the ones reported here are banned on TV, press and billboards etc just like tobacco is). Mind you we still have food companies who have no problem advising the great unwashed to choose their products because they reduce “cholesterol re-absorption” …

Cheers,

Malcolm

Hey Malcolm–

MRE

I don’t know because I don’t listen to radio. But I can tell you that it probably ain’t NPR.

MRE

I’d like to recommend some good reading to you and your readers on the subject of the drug companies. Three very different books, each one well worth reading:

The Truth About the Drug Companies by Marcia Angell. Angell was a long-time editor of NEJM and knows whereof she speaks. This book is strong stuff. In particular the chapter in which she tackles the drug companies’ perpetual refrain “we have to charge Americans so much in order to pay for all the ree-search”.

Overdosed America by John Abramson.

Selling Sickness by Ray Moynihan and Alan Cassels

I can also recommend an excellent series of articles, “Suddenly Sick”, that ran in the Seattle Times a couple of years ago: http://seattletimes.nwsource.com/news/health/suddenlysick/

Hi Karen–

MRE

I can’t seem to find any entries about Lucidal. Is it on your to-do list?

Hi Dave–

MRE

I never see drug ads shown on, say, Cartoon Network.

You’re not telling me that the baby boomers are starting to need Cialis, are you? Please don’t.

MRE

If the drugs are soooo good, why the need for heavy advertizing? The whole thing makes me skeptical. I was starting to wonder if they were just making this “restless leg syndrome” stuff up to sell drugs. According the CR video, it is a real, but rare condition, but the ads can have a psychsomatic effect in people.

Sometimes those ads make me angry, like when my 10-year-old asked, “What’s E.D.?” They talk about high blood pressure and diabetes causing E. D. There is a better solution, control your blood pressure and diabetes with low carb. I was diagnosed with both conditions and I don’t need no stinkin’ Viagra or Levitra.

Yeah, it’s hard to believe. When I was a kid and I Love Lucy was the big TV show, Lucy and Ricky had to be shown sleeping in separate beds. Now kids are exposed to the term erectile dysfunction multiple times per day. One wonders how many 5- and 6-year olds have asked their parents what that means?

MRE

I hate all drug ads, on tv or in magazines. It takes 2 pages just to list the side effects! The worst tv ad, though, was for Wellbrutin. It listed all the possible side effects, including stroke and seizures (!), but the selling point? No sexual side effects. You might be drooling from stroke or seizure, but by gum, you can have sex! (Yes, it probably helps a lot of people, but still, should that be the major selling point?) And let’s not even venture into the drugs for e.d. Again, they probably help a lot of people, but the ads are just absolutely horrendous. (What’s with couples sitting out in the wide open spaces soaking in clawfoot tubs, anyway? Does Cialis make you need a bath?)

Thanks for another informative post, Doc.

Glad you enjoyed it.