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Medical Forum / General / General / November 2005medical school professors speak out against DTCA
"The US Food and Drug Administration (FDA) is collecting public comment on prescription drug marketing." BMJ 2005;331:1040 (5 November), doi:10.1136/bmj.331.7524.1040-b News Professors speak out against advertising directly to consumers Jeanne Lenzer New York The drug industry's "onslaught of advertising to promote prescription drugs... does not promote public health" and "increases costs and unnecessary prescriptions," more than 200 US medical school professors said last week. In the United States the industry spends $4bn (£2.3bn; {euro}3.3bn) a year on direct to consumer advertising. The professors signed a petition organised by Commercial Alert*, an Oregon based nonprofit organisation that seeks to "protect communities from commercialism." The petition was sent to the US Food and Drug Administration in response to a call for public comments before an FDA advisory committee's hearing on direct to consumer advertising held earlier this week. The professors say in the petition: "Prescription drug advertising pressures health professionals to prescribe particular medications, and often the ones that may be less effective and more expensive and dangerous. This intrudes on the relationship between medical professionals and patients, and disrupts the therapeutic process." That, say the signatories, wastes valuable time as doctors are forced to "explain to patients why they may have been misled by the drug advertisements they have seen." The doctors dismiss the idea that direct to consumer advertising is "educational," saying: "It [such advertising] is inherently misleading because it features emotive imagery and omits crucial information about drugs." This, they say, is the result of an "inherent and irredeemable financial conflict-of-interest" of the drug companies, which drives them to "exaggerate the positive and minimize the negative qualities of their own products." Jeff Trewhitt, a spokesman for Pharmaceutical Research and Manufacturers of America, disagreed. "The data show a different story," he said, adding that direct to consumer advertising "is educational at a time when there is significant under-diagnosis and undertreatment of diseases that affect millions of Americans." Mr Trewhitt said that a study by the US health think tank Rand Health published in the New England Journal of Medicine "found that nearly half of all adults in the United States fail to receive recommended health care." He said, "Medications were under-used in seven conditions, including asthma, congestive heart failure, diabetes, cerebrovascular disease, hyperlipidaemia, and hypertension." Commercial Alert http://hq.democracyinaction.org/dia/organizations/commercialalert/campaign.jsp?c ampaign_KEY=1415 >"The US Food and Drug Administration (FDA) is collecting public comment >on prescription drug marketing." >BMJ 2005;331:1040 (5 November), doi:10.1136/bmj.331.7524.1040-b >News >Professors speak out against advertising directly to consumers >Jeanne Lenzer >New York >The drug industry's "onslaught of advertising to promote prescription >drugs... does not promote public health" and "increases costs and >unnecessary prescriptions," more than 200 US medical school professors >said last week. In the United States the industry spends $4bn (=A32.3bn; >{euro}3.3bn) a year on direct to consumer advertising. >The professors signed a petition organised by Commercial Alert*, an >Oregon based nonprofit organisation that seeks to "protect communities >from commercialism." The petition was sent to the US Food and Drug >Administration in response to a call for public comments before an FDA >advisory committee's hearing on direct to consumer advertising held >earlier this week. It is typical of medical people not to provide the information about alternatives and TELL patients what to do. Frankly, this should be prohibited. Doctors should provide patients with the probabilistic information about the outcomes under the various alternatives, and let the patient decide. This means that they have to realize that medical treatment is a statistical decision process, and that the patient's values are usually all that are important. >The professors say in the petition: "Prescription drug advertising >pressures health professionals to prescribe particular medications, and >often the ones that may be less effective and more expensive and >dangerous. This intrudes on the relationship between medical >professionals and patients, and disrupts the therapeutic process." Having seen the advertising, and being aware of what physicians have told me about their prescriptions, I trust the advertising more. >That, say the signatories, wastes valuable time as doctors are forced >to "explain to patients why they may have been misled by the drug >advertisements they have seen." If the patients are not informed about the differences between the choices, they are being misled by the doctors. Those professors want to establish doctors as the priests who are the only ones to interpret the medical religion. Both doctors and patients need to be educated in ways which they are not, and will not be as long as the schools, essentially run by politicians and the "schools of education", which teach how not to educate, are allowed to control the teaching of the mathematics involved. If you cannot understand what it means to tackle a statistical decision process with complicated input and output, you need to be educated as well. >The doctors dismiss the idea that direct to consumer advertising is >"educational," saying: "It [such advertising] is inherently misleading [quoted text clipped - 3 lines] >them to "exaggerate the positive and minimize the negative qualities of >their own products." That is true; should we protect the consumer from his stupidity? No, only from his ignorance, and doctors make no attempt to do this. The advertising provides a far more inclusive list of problems with the drug than I have gotten from a physician; if physicians provided the same information about their prescriptions and other directions, this might make a huge difference. >Jeff Trewhitt, a spokesman for Pharmaceutical Research and >Manufacturers of America, disagreed. "The data show a different story," >he said, adding that direct to consumer advertising "is educational at >a time when there is significant under-diagnosis and undertreatment of >diseases that affect millions of Americans." >Mr Trewhitt said that a study by the US health think tank Rand Health >published in the New England Journal of Medicine "found that nearly >half of all adults in the United States fail to receive recommended >health care." He said, "Medications were under-used in seven >conditions, including asthma, congestive heart failure, diabetes, >cerebrovascular disease, hyperlipidaemia, and hypertension." This is SO true. I have two of those conditions, and on the newsgroup for one, I am amazed by the amount of ignorance, and the belief that a "cure" is around the corner. In fact, some causal aspects of the disease are as yet unknown, but research into this has been poor, with government support (medicine is, in fact, unusual in the large amount of NON-government support) going too much toward cures, and not studying the fundamentals of the diseases. In fact, I have seen studies of drug treatments not by pharmaceutical companies which I, as a statistician, recognize are so bad as to need serious reinterpretation, as well as being badly designed. I would flunk those "medical statisticians".  SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >>"The US Food and Drug Administration (FDA) is collecting public comment >>on prescription drug marketing." [quoted text clipped - 26 lines] > to do. Frankly, this should be prohibited. Doctors > should provide patients with the probabilistic You're educated! You are a pretentious lying prick, who is so inept with language as to be a laughing stock. Please don't insult reasonable people by trying to pass off such awkward prattle as discourse from an educated man. > information about the outcomes under the various > alternatives, and let the patient decide. This means [quoted text clipped - 74 lines] > as well as being badly designed. I would flunk those > "medical statisticians". >>>"The US Food and Drug Administration (FDA) is collecting public comment >>>on prescription drug marketing." [quoted text clipped - 32 lines] > Please don't insult reasonable people by trying to pass off such awkward > prattle as discourse from an educated man. Stop jumping on Herman when he is RIGHT. The problem is that both the ads and the doctors want to get rid of probability and have you rely on trust. Herman, ANy relation to HErman MUnster?, you conveniently forget one thing. 50% of thte poulation are below average intelligence in other words they are like you in the stupid catgory. Most people don't have the faintest idea about statistics if they did they wouldn't gamble, yet millions do. > >"The US Food and Drug Administration (FDA) is collecting public comment > >on prescription drug marketing." [quoted text clipped - 107 lines] > Herman Rubin, Department of Statistics, Purdue University > hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 > Herman, ANy relation to HErman MUnster?, > you conveniently forget one thing. 50% of thte poulation are below average > intelligence in other words they are like you in the stupid catgory. Most > people don't have the faintest idea about statistics if they did they > wouldn't gamble, yet millions do. I wish we could keep this discourse civil. Not pointing any fingers (since I've been known to rock out with the best of them). But we're finally getting somewhere here! . >> Herman, ANy relation to HErman MUnster?, >> you conveniently forget one thing. 50% of thte poulation are below [quoted text clipped - 6 lines] > (since I've been known to rock out with the best of them). But we're > finally getting somewhere here! . If most people rely on trust, then we must accept that. The issue is whom do you trust most? The AMA wants you to say US. Drug companies want you to say US. The truth? Well, you need to support more research then. >>> Herman, ANy relation to HErman MUnster?, >>> you conveniently forget one thing. 50% of thte poulation are below >>> average >>> intelligence in other words they are like you in the stupid catgory. Most >>> people don't have the faintest idea about statistics if they did they >>> wouldn't gamble, yet millions do. >> I wish we could keep this discourse civil. Not pointing any fingers >> (since I've been known to rock out with the best of them). But we're >> finally getting somewhere here! . > If most people rely on trust, then we must accept that. The issue is >whom do you trust most? The AMA wants you to say US. Drug companies want >you to say US. The truth? Well, you need to support more research then. The drug companies have to tell you at least all reasonably major risk factors which are known. Doctors are notorious for not providing this information, and I have had one say that a side effect I got which was in the PDR information could not be caused by the medication. I have never gotten as much information from a doctor as the ads provide. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >Herman, ANy relation to HErman MUnster?, No. > you conveniently forget one thing. 50% of thte poulation are below average >intelligence in other words they are like you in the stupid catgory. Most >people don't have the faintest idea about statistics if they did they >wouldn't gamble, yet millions do. This is not quite true. But there is a difference between stupidity and ignorance, and they can learn IF the schools did not destroy their ability to think mathematically. I include the teachers in this, alas. When it comes to making decisions in real life, you have to "gamble". Prediction is not that easy. Physicians have a small idea of this, but that is not emphasized in their "statistics" courses, which are more "how to plug data in a computer program, and not understand what comes out". The physicians are not even aware of this; the good ones have an intuitive idea, and are willing to answer questions. If a physician does not leave the decision to the patient or the patient's representative, except if it would provide a direct threat to others, the physician should be deprived of even making a decision. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 Sorry, I tend to provoke . Do you really beleive that most people are capable of always making wise decisions? I don't. I have done things that upon reflection were extremely stupid. Sometimes others have to be relied upon. I'm not certain that critical thinking has to be "mathematical" > >Herman, ANy relation to HErman MUnster?, > [quoted text clipped - 28 lines] > Herman Rubin, Department of Statistics, Purdue University > hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 > Sorry, > I tend to provoke . [quoted text clipped - 3 lines] > relied upon. I'm not certain that critical thinking has to be > "mathematical" I tend to agree with Herman. I for one am not impressed with the medical community and consistently go on the Internet for health information. I do think the drug commercials are really annoying personally, but doctors should not try to stop drug companies from advertising their products. If doctors do not wish to explain why a drug may or may not be appropriate for the patient's situation maybe they should go into another line of work. SuperTech >> Sorry, >> I tend to provoke . [quoted text clipped - 11 lines] > drug may or may not be appropriate for the patient's situation maybe > they should go into another line of work. Communications, for various reasons, is often one of the largest obstacles. For those patients wanting to know the "why" behind a medication, I agree - there should be full disclosure about why a drug was chosen and the pros and cons of it vs others vs no treatment. The internet can be a valuable source of information - but can also be very misleading as so many people and groups have their own [hidden] agendas, such as Ilena and her website, so I urge caution and some healthy skepticism when googling something. But hey, even I do it from time to time. >such as Ilena and her website Thanks for the plug! My support group grows daily with women injured by their faulty implants and the disinformation campaigns you back. www.BreastImplantAwareness.org For the manufacturers/quack campaign attempting to silence my message: www.BreastImplantAwareness.org/quackbustersvsilena.htm I take it you are opposed to implants and those who pander to supply them. Surely the recipients must bear some responsiblity for yielding to their vanity? > >such as Ilena and her website > [quoted text clipped - 8 lines] > > www.BreastImplantAwareness.org/quackbustersvsilena.htm >>such as Ilena and her website > > Thanks for the plug! No prob - I find it a very useful example to portray an example of a dangerous, self serving website so consumed by its agenda it just put forth a mix of lies and truths without any thought to the matter. Aren't all websites self-serving? DO you know of anythat are truly altruistic? > >>such as Ilena and her website > > [quoted text clipped - 3 lines] > dangerous, self serving website so consumed by its agenda it just put forth > a mix of lies and truths without any thought to the matter. > Aren't all websites self-serving? DO you know of anythat are truly > altruistic? You have got to get to know Ilena and read all of her webpages...especially the ones where she is defaming people, attacking them and their families, etc. She brings "self-serving" to an Olympic level. >>>>such as Ilena and her website >>> [quoted text clipped - 6 lines] > >>a mix of lies and truths without any thought to the matter. >>>such as Ilena and her website >> [quoted text clipped - 3 lines] > dangerous, self serving website so consumed by its agenda it just put forth > a mix of lies and truths without any thought to the matter. If Ilena did not post lies, she would have nothing to post. >>such as Ilena and her website > > Thanks for the plug! Snippy...you snipped to change the meaning...that is called intellectual dishonesty. Here is what preceded what you snipped: The internet can be a valuable source of information - but can also be very misleading as so many people and groups have their own [hidden] agendas, such as Ilena and her website. It is well known that you are usenets most notorious netstalker and harasser and that you contact employers, spouses, families and post your fabricated URLs to defame people. >Sorry, >I tend to provoke . >Do you really beleive that most people are capable of always making wise >decisions? Who knows? If they do not have the needed knowledge, they are certainly in a poor position to do so. I don't. I have done things that upon reflection were extremely >stupid. Sometimes others have to be relied upon. I'm not certain that >critical thinking has to be "mathematical" Unfortunately, it very often has to be that in medical decisions. There is little certainty, and it is known that people are poor at processing randomness if it is not done quantitatively. They do process probabilities around 1/2 fairly well, but do very poorly away from that. It is especially the case with small probabilities. One of my doctors suggested a procedure as a possible means of treating a problem, and referred me to a specialist. The specialist gave a 5% risk of bad effects, and about a 1/3 chance that it would do the job. Both of us agreed that it would be a poor idea. Doctors can often give risks of direct bad effects of operations, but have much more difficulty of giving odds of other outcomes. A mishandled hypothetical problem was that of a choice of vaccines for a 50% lethal disease, one succeeding in 3 out of 3, and the other in 5 out of 6. The decision depends on your prior opinion of the distribution of effectiveness of vaccines, and not on the p-value, which is what medical people tend to go by, and in this case, I found by calculating that if good vaccines are likely to have a success rate well over 90% to use the 3 out of 3, otherwise to use the 5 out of 6. It is not so unusual that a reasoned mathematical approach, using the available data, will disagree with even the standard practice. Different people will evaluate results differently as well, and this goes into the utility analysis. Some people look forward to the idea of having the type of retirement which used to be considered the "standard", while other consider it to be an intolerable alternative. Treating things like this mathematically is difficult, but possible. Any self- consistent apprach needs to do this. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 Can this phony pile his sh.t high! Wow >>Sorry, >>I tend to provoke . [quoted text clipped - 45 lines] > this mathematically is difficult, but possible. Any self- > consistent apprach needs to do this. > Can this phony pile his sh.t high! Wow Although I don't agree with Herman on this issue I find his comments well thought out and stated in practical terms. Your comments are worthless, useless and a waste of time. You add nothing!!!!!! Interesting. Believe it or not I have a pretty fair idea where you are coming from. One point though is that some decisions regarding healthcare are tend to be of the catagory of "if you don't you will die". > >Sorry, > >I tend to provoke . [quoted text clipped - 49 lines] > Herman Rubin, Department of Statistics, Purdue University > hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >Interesting. Believe it or not I have a pretty fair idea where you are >coming from. One point though is that some decisions regarding healthcare >are tend to be of the catagory of "if you don't you will die". It is not that straightforward. One cannot always say which treatment is more likely to kill you. Also, the quality of life can be affected. If you had hearing problems, would you undergo an operation which could make your hearing "normal", but could also leave you deaf? SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >>Herman, ANy relation to HErman MUnster?, > [quoted text clipped - 10 lines] > did not destroy their ability to think mathematically. I > include the teachers in this, alas. Your statistics course must be a total gas Herman. >>"The US Food and Drug Administration (FDA) is collecting public comment >>on prescription drug marketing." [quoted text clipped - 29 lines] > a statistical decision process, and that the patient's > values are usually all that are important. Probabilistic outcomes have nothing to do with television advertising. The job of ads is to stop people thinking about outcomes. In short, the AMA and the ads have the SAME goal Herman. Wake up. It is a jurisdictional dispute about who gets to tell you what to do, NOT worry about outcomes. Neither side wants that. Just try Vytorin for the bullshit which comes from both sides of the family. -:) >>The professors say in the petition: "Prescription drug advertising >>pressures health professionals to prescribe particular medications, and [quoted text clipped - 5 lines] > physicians have told me about their prescriptions, I > trust the advertising more. Pity. Both are the same in their goals. Both want to tell you what to do. : (765)494-0558 >>>"The US Food and Drug Administration (FDA) is collecting public comment >>>on prescription drug marketing." >>>BMJ 2005;331:1040 (5 November), doi:10.1136/bmj.331.7524.1040-b >>>News >>>Professors speak out against advertising directly to consumers >>>Jeanne Lenzer >>>New York ..................... >> It is typical of medical people not to provide the >> information about alternatives and TELL patients what [quoted text clipped - 5 lines] >> a statistical decision process, and that the patient's >> values are usually all that are important. > Probabilistic outcomes have nothing to do with television advertising. >The job of ads is to stop people thinking about outcomes. In short, the AMA >and the ads have the SAME goal Herman. Wake up. It is a jurisdictional >dispute about who gets to tell you what to do, NOT worry about outcomes. >Neither side wants that. Just try Vytorin for the bullshit which comes >from both sides of the family. -:) At least the ads tell you much more about the dangers than the doctors do. Several doctors have tried to get me on statins, and I tell them bluntly that my reading of the inadequate data there tells me not to. They can read the same stuff that I have read; I do not have any special sources here. >>>The professors say in the petition: "Prescription drug advertising >>>pressures health professionals to prescribe particular medications, and >>>often the ones that may be less effective and more expensive and >>>dangerous. This intrudes on the relationship between medical >>>professionals and patients, and disrupts the therapeutic process." What they mean by "disrupts the therapeutic process" means that the doctors have to discuss the advantages and disadvantages of different treatments. >> Having seen the advertising, and being aware of what >> physicians have told me about their prescriptions, I >> trust the advertising more. > Pity. Both are the same in their goals. Both want to tell you what to >do. It is widely recognized that advertising pushes products, usually without comparing them to alternatives. There is no indication of authority. On the other hand, there is the claim that a doctor will tell you THE best thing to do. THAT should be immediate grounds for malpractice. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >>>>"The US Food and Drug Administration (FDA) is collecting public comment >>>>on prescription drug marketing." [quoted text clipped - 29 lines] > At least the ads tell you much more about the dangers than > the doctors do. Only in type so fine you cannot read it on TV. Maybe on the printed ads, yes, they do. Is that better than the doctor? Maybe you are right. Several doctors have tried to get me on > statins, and I tell them bluntly that my reading of the > inadequate data there tells me not to. They can read the > same stuff that I have read; I do not have any special > sources here. Doctors pretty well have to put everyone on statins these days. Sure they can read, but you know, doctors are not judged by science, but by the UCR criteria. They have to recommend statins. You can say no, and you need to also if you have the slightest concern about cancer. Low cholesterol=high cancer risk. >>>>>"The US Food and Drug Administration (FDA) is collecting public comment >>>>>on prescription drug marketing." >>>>>BMJ 2005;331:1040 (5 November), doi:10.1136/bmj.331.7524.1040-b >>>>>News >>>>>Professors speak out against advertising directly to consumers >>>>>Jeanne Lenzer >>>>>New York ..................... >>>> It is typical of medical people not to provide the >>>> information about alternatives and TELL patients what [quoted text clipped - 5 lines] >>>> a statistical decision process, and that the patient's >>>> values are usually all that are important. >>> Probabilistic outcomes have nothing to do with television advertising. >>>The job of ads is to stop people thinking about outcomes. In short, the [quoted text clipped - 3 lines] >>>Neither side wants that. Just try Vytorin for the bullshit which comes >>>from both sides of the family. -:) That one is not "bullshit"; heredity is VERY important here. >> At least the ads tell you much more about the dangers than >> the doctors do. > Only in type so fine you cannot read it on >TV. Maybe on the printed ads, yes, they do. Is that better than the >doctor? Maybe you are right. I have seen TV ads, and they put lots of it verbally. There is little in writing in those ads, except the logo of the drug involved. > Several doctors have tried to get me on >> statins, and I tell them bluntly that my reading of the >> inadequate data there tells me not to. They can read the >> same stuff that I have read; I do not have any special >> sources here. > Doctors pretty well have to put everyone on statins these days. Sure they >can read, but you know, doctors are not judged by science, but by the UCR >criteria. They have to recommend statins. You can say no, and you need to >also if you have the slightest concern about cancer. Low cholesterol=high >cancer risk. Studies in peer-reviewed journals many years ago found that the explanation of the demographic fact that oldsters tend to have higher cholesterol is due to the infection-fighting properties of cholesterol; this effect was also found in younger people. This might be related to the effect on cancer. Also, there is some effect on memory. But even worse is that, according to what I can conclude from even the poorly done published studies, that many are put at a HIGHER risk of cardio-vascular problems from statins, and that one can identify many of these by using a decent multivariate analysis on the SAME data. I have only seen partial breakdowns, and they are enough to conclude that this should be the case; the analysis here was not even multivariate. So, who does one sue about the overuse of statins? It is not the fault of the manufacturers, but of the medical profession. I support INTELLIGENT use of them, and we have evidence which any good statistician can spot that this is not being done. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >>>>>>"The US Food and Drug Administration (FDA) is collecting public >>>>>>comment [quoted text clipped - 77 lines] > have evidence which any good statistician can spot that > this is not being done. Medicine is basically a business, NOT a profession. What is really disturbing are the studies which show that an elderly person put on statins has about a 22% chance of being diagnosed with cancer the year following the start of statins. Now, correlations are not cause and effect, but still, Herman, something really bad is going on here. My wife had been put on beta blockers, which caused her to faint, go into atrial fib and a host of other problems. Atrial fib put her in bed it was so bad. How did she get better? She stopped the beta blockers and suddenly her health improved about 100%. Too much medical care = illness. |
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