My own example–I struggle w/ allergies. Bad ones. Dr. suggested a switch to a different type. I’m willing to try, as I knew about them through both the ads and a friend’s experiences, but I asked if he could prescribe one that would be on a a cheaper tier of my insurance. He prescribed one that is on generic. And he gave me a sample of the branded one to boot.

So, DTC ads, sales reps, my doctor, my insurance and I all worked together to get me a drug that isn’t advertised and isn’t represented by a salesperson. I didn’t need a gov’t counter-detailer, and I didn’t need a DTC ban. In fact, I would have been less prepared to make that decision were it not for the ads.

I agree that you can’t assume a drug is bad simply because it’s the subject of a DTC ad. More importantly, I don’t think consumers should assume a drug is *good* just because it’s the subject of a DTC ad. I think that’s the real problem because patients ask for drugs they know only through the ads. I wouldn’t be surprised if some currently advertised products end up on the WHO list, but I would be somewhat surprised to find one on the list while it is still being advertised.

My views on DTC are mixed.

Again, I just don’t think you can claim an advertised drug is a bad drug. With no data (historical or otherwise - since DTCs relatively new), I predict drugs advertised today will make that list when they go off patent.

I’ve seen Tylenol commercials, and Tylenols on the list. There used to be Zocor DTC as well.

In 1996 Merck spent 40 million on Zocor DTC. Was simvastatin on the WHO’s list in 96? I don’t know, but I suspect it was not.

From the WHO website:

“Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness.”

So the list doesn’t consider efficacy alone, but rather within the context of several other factors.

re: atorvastatin vs. simvastatin I agree they’re different, but “superiority” isn’t always obvious. Sometimes “good enough” is, in fact, the best choice.

I just think that DTC can get in the way of reasoned decision making in the choice of medications by unduly influencing patients who do not have adequate understanding of the variables to make a truly informed choice. Drugs are sold by prescription only in large part to ensure the choice of medication is appropriate to the individual case.

I personally think that there’s a difference between those two drugs, but is the difference big enough to justify spending for a brand-name med in a 3rd world country?

Would you at least admit that the WHO list is biased towards first-in-class medications, and well-established meds? I think some drugs (or drug classes) with current DTC campaigns (or past DTC campaigns) will crack that list.

That’s exactly the point. In many cases there is no therapeutic need for the more expensive option, although DTC advertising can suggest otherwise to patients. That isn’t to say that the more expensive option isn’t appropriate in some cases, just that higher cost (or the existence of DTC ads) doesn’t necessarily mean a superior option for the patient.

If you look at the WHO list of essential meds, you’ll notice that almost all of the many antiretrovirals are NOT off patent and are not available as generics in the U.S. You’ll also note that these products are not, as far as I know, the subject of DTC ads. Clearly, companies engage in DTC when the believe it will help boost patient demand, regardless of the therapeutic benefit of the product. I think the absence of products with DTC ads from the list of essential medicines underscores the point that they are not necessarily the best therapeutic option. Certainly if they were so vastly superior to other treatment options, they’d be on the list.

But if I scan the WHO list of 100 essential meds, I can find meds that in my lifetime I remember seeing DTC ads for. On top of that, DTCs a relatively new thing, and it’s basically impossible for a brand name med to get on that list, so I think at least some meds that you see ads for today will make the list in the future after the patent expires.

We can debate whether or not DTC makes sense for a lot of reasonse. But I don’t think the quality of the med determines whether DTC makes sense. Currently, the therapeutic area really determines whether or not you will see DTC - almost regardless of whether the meds one of the “best” meds - whatever that means.

So…patients are left alone in trying to find out information for themselves. DTC is definitely biased and too glossy to be useful. However, is the rest of the crap (sorry Ed) in the internet any better?

There’s got to be a more comprehensive solution than only regulating DTC ads; that will help some, but won’t make much of a dent.