Also agree many factors, including other corporate arenas (Enron, etc.). Of course, this is one of those things that’s essentially impossible to pin down one way or other. We can track the correlation of DTC with scripts written (and speculate about possible causal links) but almost certainly not attitudes in the same way, which are more variously conditioned, less malleable once formed, etc.

You won’t be surprised if I think “shooting themselves in the foot” is a little mild for _some_ of the “bad behavior” (and those who also got shot in the process), but generally in accord. I would add that pharma is different from other industries because of how much most of us depend on their _avoiding_ “bad behavior_. That is, how much we essentially _have_ to trust the industry. To that degree, they are also in the position of docs - inevitably, our views our going to be fickle. And they should be. That’s part of what goes with taking on this work and not some other.

As I’ve often said, when a social scientist messes up, nobody gives a sh*t.

In my opinion, Phil Hilts gives Americans far too much credit. I frankly don’t believe that Americans care all that much about AIDS in Africa, certainly not enough to impact our thinking about health care in the US.

Overall, I think the decline is multi-factoral–increasing patient out-of-pocket expenses (this includes rising prices, increased utilization and increasing co-payments); the aging of the baby boom generation and the need to treat the conditions of middle age; a changing attitude and skepticism about corporate America; the pharma industry shooting itself in the foot with bad behavior; etc. DTC is part of that equation, but I don’t think it has any greater role than the other factors.

Atlex

Phil Hilts, whose book on FDA you probably know (but probably don’t like) thinks the key was pharma’s initial balk at responding to the need for AIDS meds in Africa at that time (’97). I frankly think he thinks too much of us!

I would argue that DTC combined with a number of other factors–profitability, politics, the aging of the baby boomers (with unreasonable expectations for perfection in everything) and others issues–have all contributed to the decline.

My sense has always been that if you sell drugs like they used to sell cigarettes, there’s a loss of a certain amount of “gravitas.”

As we all know, the “free speech” argument is a straw man that needs to be set aside already.