Ok, let me try the DTC defense one more time. This week two critiques of DTC appeared in the press. One is from The Huffington Post by well-known natural remedy doctor and author Andrew Weil. The other is by The Century Foundation, a progressive think tank.

First let me critique Dr. Weil’s piece. He basically argues we overuse Rx drugs when natural treatments are readily available. It is of course very convenient to advocate natural remedies over Rx drugs. Everyone loves the word natural and would not any sensible person prefer the natural remedy? No, the sensible person knows many of the natural remedies have no firm clinical proof of efficacy. In fact, much of the natural remedies are downright dangerous with unproven doses and numerous toxic side effects. Anthrax is natural, so is plague, and radioactivity.

If all these natural products worked so well then GNC stores would be bigger than Wal-Mart. Some natural remedies do work but most have no firm clinical study evidence or FDA seal of approval. Some get withdrawn after discovery of toxic side effects. Many are taken in absurd doses and are just expensive snake oil.

Dr. Weil also resents the use of actors to give information on drugs. He cites Sally Field as an example of an actor misleading women. I guess Dr. Weil does not know that every DTC statement must be in the drug label and approved by FDA. It does not matter whether a doctor or actor says the lines.

Dr. Weil thinks drug ads make consumers think there is a pharmacological solution to all ailments rather than changing lifestyle. Drug companies do not control peoples’ lifestyle choices. Should we not have treatments hoping instead for better lifestyle habits? I agree consumers are their own worst enemies in poor diet and exercise habits? Would banning DTC change that? Is DTC somehow preventing people from living a better lifestyle?

He also says advertised drugs have side effects and are sped to market because of political interests. Do you have any proof of that sir? Yes, some drugs are found to have additional side effects post market. That is true of many remedies, especially unregulated natural ones. Bad drugs do make it to market but we must accept some risk to get the good drugs out in a timely manner.

Finally he says ads circumvent better sources of information and are too emotional to provide useful information in 30 seconds. DTC is designed to get people to investigate further, nothing more. Millions of consumers use more detailed resources as a follow-up to that TV ad.

Dr. Weil also wrongly says DTC gives a 4 to 1 return on investment. That is from one outlier study done about 5 years ago. Many more studies say DTC is much less effective and gets a 2 to 1 return. Those studies are updated every year and have been consistent in ROI analysis. Most critics fail to put DTC in the context of how little influence it has on increasing sales. Drug companies do it because it has a good return not because it is the driver in building brands.

The second piece covers much of the same ground. The Century Foundation does not like DTC because they see it as too influential in drug decisions and assume that DTC has contributed to rising health care costs. I have debunked that myth many times but no critic wants to hear that reality.

The article also does not like the “hawking of drugs” in a brief television ad. They claim the implied FDA endorsement is making consumers trust the ads too much. Of course they forget to mention consumers cannot buy Rx drugs directly and their doctor must agree to write it.

I also heard Howard Dean in a town meeting on health reform say he does not like DTC. He was pandering to popular sentiment that drug ads must be raising drug costs. He did say drug companies’ products provide good cost/benefit. Somehow that positive feeling for drugs does not translate to publicizing them. Somehow that is a contradiction, Dr. Dean.

So, my colleagues, we have a lot of work to do debunking myths about DTC. Somehow DTC has caused, in critics minds, a vast increase in health care costs. That $4 billion sure can cause that $2.4 trillion to soar. That would take about 100 to 1 ROI versus the real number of 2 to 1. Sorry critics but you just do not have facts to make your case. Instead you rely on anecdotes about offensive ED ads or phony claims that DTC ads make false statements. I will keep trying to set the record straight but DTC remains a favorite target.

It is nice to comment on a positive DTC story for a change. A study done by the Dana- Farber Cancer Institute released this week in The Journal of Clinical Oncology showed 57% of consumers surveyed suffering from cancer said DTC helped them have better discussions with their doctor.  They also found 62% said they became aware of treatment options from DTC.

The study did caution that some consumers(11%) were less confident of their doctor’s judgment after seeing DTC. They concluded that DTC “was found to be accessible and useful.” The frequent concern that critics have that DTC changes doctor behavior was not found to be a problem. Only 17% of those surveyed talked to their doctor about a specific medication. Only 3% received a medication they requested.

This study is similar to most DTC studies in that DTC is seen as a net positive. It does not lead to mass mis-prescribing  behavior. Patients like it because they learn new things from DTC. They feel more prepared to discuss their treatment with their doctor. I would venture to say therefore that Henry Waxman has little to fear from DTC. Patients are not hoping he and other legislators protect them from DTC. I would also guess most Americans fear government control of information more than the claims of DTC.

The critics think Americans cannot distinguish advertising from totally objective sources. They can. Americans are skeptical of all advertising and they approach DTC with caution. DTC gives them a basis of discussion with their doctors. That is better than total ignorance. Informed consumers who see a DTC ad for their condition will likely then go to the Internet to follow-up. Using a search engine they see fuller pros and cons of the drug mentioned. DTC serves as a stimulus for further investigation.

I hope Congressional critics can ultimately agree that more information is better. If they want to provide more objective critiques of drugs through some panel of experts by all means do so. DTC is only one source and government can play a role in expanding information sources. We can call it the Public Option for Drug Information. That is a public option that I would welcome.

                                                                Latisse Gets Lashed

Can DTC withstand the attacks on the latest campaign to be the butt of critics’ jokes? Latisse is Allergan’s product for growing eyelashes. Not one to focus on my eyelash length I am not an authority on the problem of short eyelashes. I will try, however, to take a position on the issue.

First, let’s defuse much of the attacks. In most cases no third party is paying for use of Latisse. The consumer will pay full freight of about $100 a month. Therefore, this DTC is encouraging consumption of a product that will not cost employers or taxpayers anything. You will not see a flood of Medicaid or Medicare patients costing the government money.

Second, given the first point, it is not an issue what Latisse does for its DTC campaign.  I read the consumer reviews on Latisse on the web. Apparently women, and I guess a few men, love this product. On one site with 57 reviews 88% were positive. So what we have is a product that does what it promises for a price that women seem willing to pay. Allergan is doing what any red-blooded American company is doing in the cosmetic improvement business. That is, convince women that those short eyelashes can and need to be lengthened. Yes, Latisse DTC is designed to sell, sell, sell! If American women want to spend $100 a month on eyelash medicine, that is their right. Obviously, I hope they pay their mortgage, feed the kids, and pay their taxes before considering Latisse.

Undoubtedly further angering the DTC critics, Allergan is using celebrity Brooke Shields. Critics hate when DTC ads use celebrities. It angers them that “gullible” Americans fall for celebrity pitches. So we have critics enraged that short eyelashes actually have a medical name(hypotrichosis) and that our celebrity worshiping population is exposed to such a pitch.

As someone that wants to see DTC remain, it does concern me whenever lifestyle products cause an uproar from critics. That is not Allergan’s problem, however, the same way it is not a Cialis, Viagra, or Levitra, problem. Every company should do what it can to sell what it makes despite a contrary view from some critics. We have FDA to monitor what they sell and say. If the DTC Industry has to take some heat because what they sell is not seen as essential to health; so be it. I know the drug industry is skittish about DTC criticism using the defense that it promotes diagnoses and disease awareness. Whenever a cosmetic or lifestyle product uses DTC it makes that argument less convincing. We cannot, as an Industry, be half-pregnant in our defense of DTC. It is ok to say DTC is meant to sell products and there is a chance people use things that they do not need. The FDA does surveys to ensure the level of inappropriate prescribing is acceptable.

The more I hear critics want to restrict DTC, the less convinced I am of any merit in their arguments. Information, properly regulated for accuracy, is never a problem. Congress is the one with an accuracy problem, spinning their bills to say everyone benefits when they know that to be false. Of course I am referring to health reform bill and the Democratic talking point ban on the use of the term rationing.  I wish we had a regulatory body to make sure Congress was telling the truth. Alas, that is off topic but I could not resist the jab. So Latisse, do what you do proudly and sell hypotrichosis. It is clear that some leading Congresswomen already love your Botox and I am sure the same ones will or have already used Latisse.