Morality is not objective, determining it is not an evidentiary process.

In my view it is that combined with the welfare reform act. Once welfare was limited to 5 years people moved to SSDI to receive payments, opiate drugs became more popular and now we have a system when the government will pay you and give you heroin if you jump through the right hoops. As we have effectively subsidized addiction it shouldn't be surprising that it has increased dramatically.

Gruits were medicinal herbal meads - funny to think that in not-so-distant history, a doctor may have prescribed one of several "medicinal beers".

It's interesting how molecules can be considered 'food', 'medicine' or 'poison' in different contexts.

A huge part of it is education when it comes to drug advertising.

Talking to my European colleagues, it’s not that different from the US (although the specific rules can differ).

Personal and non-personal promotion is how it’s done in Europe.

Consumers who care enough about the medicine they’re taking to request certain prescriptions want to understand them. Mass media like TV ads drives searches and visits to more detailed official material (websites, pamphlets, etc.) Without providing useful information, the manufacturer would have trouble convincing more engaged patients to switch, and similarly to other product markets, engaged customer word of mouth is vital to growth. Word of mouth is bolstered by the more familiar mass media. It’s not perfect, but it’s far from axiomatic that the communications from the entire marketing campaign are valueless. It only appears that way to TV viewers with no medicinal motivation to research the drug.

I can see advertising that a condition exists and or a treatment for it exists. But, I have no idea why naming a specific drug benefits the public.

I think the takeaway is that is already available and doctors don’t consistently use it.

This study tested kids but it supports the argument you made, and it's pretty reasonable to assume it applies to adults as well. https://www.cbc.ca/news/kids-think-food-in-mcdonald-s-wrappe...

Sure, “all” is a powerful word. It was simplistic enough to support my point, which still stands though. Perhaps it is more useful to discuss the central point on debate, instead of being picky on points that are not central to the debate?

I get what you mean, really, but it is not what I’m talking about.

Depending on the country, the “companies” that you mention have a different legal status than an enterprise / business kind of company. I think my point was clear: not only management consultants are the ones who seek to make money out of their business.

And of course to belabor your point, if private hospitals and bakeries and carmakers are all in to make a better world, up to that standard of idealism, consultants are there too.

I feel that you're describing companies as they should be, while the quoted comment line is describing them as they have become treated.

I believe the list is shorter if you make it about which countries allow direct-to-consumer advertising:

USA, New Zealand.

That's it.

GP is talking about all drugs, not just prescription drugs.

I'm not a fan of drug advertising (I want it regulated, not banned) but I don't see how it's categorically different than other advertising.

Chronic pain (and a whole host of other issues) aren't life threatening. Until the mid 20th century people just lived with chronic pain and tons of other things. Look at the kinds of TV ads you see, they're for drugs that minimize the symptoms of some some negative, but not life threatening thing. These are not essential products. They're luxuries of modern life that we consider to be nearly essential. Depending on one's specific situation having a smartphone or car may actually be more "essential" to daily life than having one's condition treated.

As an aside, drugs that actually save lives don't seem to get marketed much.

I don't think they would. Do they currently have instagram drug influencer in Europe, where direct-to-consumer drug advertising is illegal?

https://en.wikipedia.org/wiki/Direct-to-consumer_advertising

Actually, big pharma does both. Marketing to doctors is sometimes even more sinister, because of (often implied) incentives for pushing more of a medication on the physician's patients.

Some resources:

[1] https://www.sciencedaily.com/releases/2018/05/180514132441.h...

[2] https://www.pewtrusts.org/en/research-and-analysis/fact-shee...

Plus, this classic Scrubs clip describing a particularly chauvinistic (but truth-in-television) take on the practice: https://www.youtube.com/watch?v=VMXa0U4WZyU

That's only in two countries in the world (NZ and USA).

You realize there are a handful of therapeutic areas where they are really competitive?

It’s inaccurate to suggest that’s the only market for drugs.

Because consumers aren't stupid and that doesn't work, probably? Because your competitor will gladly advertise their more innovative and better product, and yours will look inferior?

I live in a single-payer system in which advertising is banned, and I know every drug that could potentially be taken for my condition and all the upsides and downsides of them, including some side-effects that my doctors refuse to believe are a thing.

There's no way the only possible method of resulting in having informed patients is to put them directly in the middle of a struggle between big companies and doctors. I'd argue that putting doctors in a position of power is terrible (whether single-payer or not), but giving pharma companies' marketing departments the freedom to manipulate people with advertising is also terrible. Two wrongs do not make a right - adversarial systems are poor designs.

How about we periodically publish a big book that lists all approved drugs, their uses and side effects, and send it to every residence in the country like we (used to?) do with phone books.

There are 20-some people running...I wouldn't call them a presidential candidate yet...more like presidential hopefuls.

And because big pharma seems to always win.

Because the people that will likely win the nomination will almost certainly have big money, to include Big Pharma, behind them. Ads, research, propaganda, and aggressive ground games work, but they need money. Like multi-national corp or nation-state level money[1].

Hilary had some uncomfortable ties to Wall Street -- she was a Senator from NY, mind you -- and the DNC chair Debbie Wasserman-Schultz picked up a lot of Budweiser money by scrapping any DNC talk of Marijuana Legalization (DWS has long battle MJ Legalization in Florida, so she's been taking their money for a while, or was a sympathetic bribe for Alcohol). But I could have lived with that in exchange for working health care and sane foreign policy.

[1] see also: the russian firehose of propaganda -- https://www.rand.org/pubs/perspectives/PE198.html

>I find the argument that humans will stop studying pharmacology if they can't monopolize their results quite unconvincing.

agree

>Current pharma co R&D and innovation only effectively investigates the benefits of drugs with recent patents (with enough years remaining to monetize).

Can you elucidate the connection to your first statement - I don't see how that follows.

The vast majority got their start in academic settings. Most of the R&D money (in particular the expensive phase 3 clinical trials) is spent by pharmaceutical companies.

Nobody needs to discover what drugs are suitable for them. This is medicine, not a restaurant menu.

If you're diagnosed with a medical condition or have a specific ailment, then you can investigate potential treatments.

The status quo "compromise" solution gets this exactly backwards. "This drug will make your life better. So ask your doctor so they'll comb through your medical records and history looking for something kind of like what we claim to treat[1], so they can prescribe our drug for you." Lies and failure to mention side effects are not the only problem with advertising. The problem with advertising is that it seeks to persuade people, using every trick in the book short of actionable lies and omissions, to buy drugs that even doctors can't properly evaluate because drug research is pathologically flawed. And those advertising tricks are effective at getting people to buy drugs which they don't need and which will do harm, because most drugs do some kind of measurable harm whether it's potential liver or kidney damage or increased risk of dementia or cardiovascular problems or cancer or whatever.

Pharma companies that seek to extract rent from your "conditions" are the last entities you want telling you what you might have, and they're the least trustworthy entities to be allowed to get you thinking that their drug might be your best option for treating your "condition" because you heard about theirs first and they made sure their advertisement stuck a bunch of positive associations to it in your mind.

"Ask your doctor about our drug instead of asking for advice on whether other things, including exercise, eating better, and getting better sleep might help, because those take time and effort and you have no time and no willpower except when you're dancing in a field of flowers like we showed you doing when our drugs solve all your problems so you should pay us rent for life for your 'medical condition'."

[1] Have you noticed most drug advertisements don't even claim to treat anything specific, or are intentionally vague? The charitable explanation is that the condition is often something taboo or embarrassing, but I think a bigger part of the reason is that pharma doesn't want you losing interest in the drug before you ask your doctor about it.

A very interesting read for me was an FDA survey on direct to consumer TV ads for drugs.[1]

A few of the negative findings:

-Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

-In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.

And positive findings:

-Many physicians thought that DTC ads made their patients more involved in their health care.

-Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.

-The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.

[1]https://www.fda.gov/drugs/drug-information-consumers/impact-...

I simply wondered if I could play devil's advocate by looking up some research about men spending money for cars in order to attract women. I mean, most psychologists are men right? Surely, someone had the bright idea to look into this (I wonder if anyone has done it regarding the other way around, I'm too lazy to look it up since I can't play devil's advocate with that). As it turns out, there is research on it!

The introduction is the most juicy bit as the particular article I found is about intra-sex competition but states a few interesting studies in their introduction about being desirable to women.

In short what I skimmed so far related to this idea is:

"And indeed, a man who was seated in a luxury car was perceived as more attractive by women compared to the same man seated in a nonluxury car (Dunn & Searle, 2010). Hence, men appear to use showy spending to attract women in intersexual competition contexts. Sundie et al. (2011) further revealed that men’s flaunting of luxury goods signals their desirability as a shortterm (rather than long-term) mate."

Personally, I don't car about any of this. However, academically (from an evolutionary psych. view, lol): yes, men are seen as a more desirable mate!

If this conclusion is also actually true (and not subject to whatever ails the field of psychology) then I'd chalk it up to most of humanity being vain and if you want to get vain people you need to be the vainest of them all and get the sports car, the fancy house, other desirable 'high value' women in pictures and all that jazz. Though, why not just immediately go for the private helipad and private jet with built-in Jacuzzi? Nothing attracts as much as offering young people in general a trip around the world in pure luxury! Or so I presume. So don't buy the sports car. Buy the helipad with helicopter on top.

Source

Title: What If the Rival Drives a Porsche? Luxury Car Spending as a Costly Signal in Male Intrasexual Competition

DOI: 10.1177/1474704916678217

URL: https://journals.sagepub.com/doi/pdf/10.1177/147470491667821...

> Look at car ads. Do they say "The new 2019 models are available"? A few do. Do they say "This car gets better gas mileage" or "This car is safer"? A few do. Most say "If you drive this car, you'll get the hot girl". That's not "educating consumers". That's trying to make consumers want your product on the basis of something completely unrelated to your product.

You and I must be watching different commercials, because I see far more of the former.

> Management consultants nearly always have a conflict of interest though (i.e. the preoccupation of consultants is almost always "sell, sell, sell" rather than "help the client make money") due to the nature of their work and their short-term contact-based engagements mean they rarely have to stick around and deal with the messes that they create.

Not my experience at all. If you show value to the client and you build a trust relationship then you enter into a relational mode that is fruitful for both sides, and you skip/streamline all the tedious commercial topics (RFPs, competitors, beauty contests, the purchasing department demanding a 3% discount...). On the other hand, if you want to milk the cow dry then you end up on a very transactional relationship and you need to start cold selling from scratch after every project, which takes a lot of effort, time and energy.

In any case, again, the conflict of helping the client vs. overselling is hardly a consultant-specific topic; I’d say the smaller the shop, and the closer the ownership to the sales team, the more pressure there will be, in general. Case in point: the actual doctors that overprescribe opioids!

>i.e. the preoccupation of consultants is almost always "sell, sell, sell" rather than "help the client make money"

The hilarious part for me, as an independent consultant, is my partner and I often agonize over how to help the client make money in spite of themselves.

I'm not disagreeing with you---if we were employees for a big-c Consulting Firm we'd likely be under the gun to act as you describe whether we wanted to or not, and what we offer is definitely different from the most common experience people have of working with a consulting firm, but it's just funny for me to read.

I think that’s a good compromise.

BTW, it’s actually pretty common in many US states for pharmacists to be required by law to fill prescriptions with their generic equivalents.

Maybe an alternative to drug marketing would be to have an independent national or international group (e.g. NIH or CDC) inform doctors about new drugs based on their prior prescriptions, and to present the preregistered clinical trials at medical conferences just like any other research result to reach the rest.

My counter to your comment, and my own personal experience, is that doctors are fully aware of the manufacturers conflict of interest. They know that the drug companies will present everything in the best possible light.

Other things that exist to counter this bias are competitors, who will provide a different perspective and most importantly, the FDA that regulates all pharmaceutical promotion for accuracy and will quite swiftly drop the hammer on a company that bends the rules.[1]

[1]https://www.fda.gov/drugs/warning-letters-and-notice-violati...

>They're incentivized to encourage doctors to use the drug that makes their company the most profit, not the drug that is best for the patient.

The job of the marketing department isn't "best drug for patient". That's the doctor's duty. The marketing department is there to bring awareness of the product to both doctor and patient. There is no conflict of interest at all.

I appreciate how you said “tends to sell itself”.

Before I got in the industry I thought “what the hell does marketing do?”. Then once I saw what they do, I realized, no, most drugs don’t sell themselves, there is too much inertia for doing the same old thing.