Drug companies defend DTC by arguing it creates disease awareness and information on treatment options. Critics of DTC say it pushes high price drugs and creates undue pressure on physicians to prescribe branded drugs when alternative treatments are just as good. An article in the March 23 issues of US News and World Report written by Dr. Kevin Campbell is representative of the anti-DTC position.

The reality is DTC may do what both supporters and critics say. There is no doubt DTC raises disease awareness. There is also legitimate concern that we may take drugs more often than needed. Drug companies benefit from disease awareness by eventually selling more drugs. While drug companies advertise to sell more of what they make, that does not mean consumers are not also being helped.

In fact, DTC lets patients know what new treatments are out there for consideration. That is all DTC can and should do. Drug companies are not objective sources of information. What they say should be vetted by regulators, physicians, payers and consumer advocates. We cannot assume that anyone else involved is objective. Payers want to spend as little as possible whether they are private or public. Physicians have their biases as to which drugs to use and many are slow adopters of new treatments. No one cares about your health as much as you do.

Therefore DTC is just one part, but an important part of the patient’s information set. Unfortunately, there are competing motives in deciding which drug to choose. Patients want the best treatments regardless of what it costs payers. Payers want cost efficiency and are willing to settle for les than perfect treatments. For example, what is the extra few months of life worth to you versus what it is to a payer? That dilemma exists in many end stage cancer treatment decisions. Ads for Provenge and Opdivo for prostate and lung cancer are offering just such hard treatment choices.

Hep C drugs costing $80,000 are another hard choice. The cure is expensive and payers are assessing the benefit of treatment versus other options. Patients want the cure but payers may be reluctant to spend the $80,000 on you. DTC, alerting people of their options, serves a catalytic purpose.  Payers might want to delay covering the new drug to take their time studying its economic value, while patients want to get better now. DTC forces the discussion of coverage sooner.

DTC critics like to say drug selection is a complicated decision best left to the physician. That argument is nice in an ideal world where cost is not a factor. We all know that payers want to pay less and sometimes that means delaying, denying, or refusing coverage. Those payers make doctors go through hoops to argue for reimbursement and being busy folks they can get discouraged. Without pressure on payers, patients lose.

Of course drug companies do DTC to increase sales, not to be Mother Theresa offering selfless advice. They want to increase demand. While it sounds better to say they want to increase disease awareness, they advertise to increase sales. So what is wrong with that? Drug decisions for all constituencies are cost/benefit based. Patients, through DTC are given reasons to ask about the advertised drug. Physicians and payers can accept or reject those reasons. It is messy and sometimes inconvenient for physicians to deal with patient requests. That is the new reality of the information age. Going backwards to restrict patient information is not wise or viable.