Editorial

Direct-to-consumer Ads and the Rheumatologist: Time for Value-based Care Approach

One of the best parts of penning my monthly editorials for Healio Rheumatology is the opportunity to let the spirit move me on occasion. This month, direct-to-consumer advertising of drugs — and in the rheumatology world, that is largely biologics and biologic-like agents — has finally arrived.

What follows may sound somewhat random given that I am no expert on this subject; however, as a qualification, I will state that I do watch the evening news with my wife and we often have a mini-lottery on what drug will be featured in the next commercial (which I frequently win).

Leonard H. Calabrese, DO
Leonard H.
Calabrese

With this background, let’s first start with some facts: direct-to-consumer (DTC) advertising is big business. In 2018, pharmaceutical companies in the United States spent $3.7 billion on television advertising alone — and much more if we included other media! Secondly, it must be noted that in the entire world only the U.S. and New Zealand permit such advertising; I’ll let someone else explain the New Zealand angle. Thirdly, these ads must work as no company would invest this much money unless there was some clear return on investment (ROI).

Given these facts, there are a number of potential upsides I can see, namely that some patients may feel better informed and empowered by such ads; however, the declarative knowledge that patients acquire remains in doubt. These ads may also stimulate discussions with health care providers, which I have witnessed firsthand.

But what about the potential negatives? To start, I would say that meaningful messaging about complex therapies is difficult, if not impossible, to convey in the span of a TV ad. While some of the messaging is indeed empowering — medications offering hope and patients taking control of their disease — I don’t think anyone would admit that the adverse event profile is reasonably conveyed. Muted, monotone delivery during pictures of joy and beauty are not really optimal.

Ask yourself: Would you explain potential adverse events to your patients like this or would you be satisfied to hear them delivered this way? These ads also have been criticized for emphasizing imagery (happy, happy people) and misrepresenting statistics, which can be misleading at best.

There is however one kind of DTC ad that I personally like, which is referred to as “Disease Awareness” in which no drugs are mentioned. I particularly like the Gilead-sponsored hepatitis C virus ads. These ads are analogous to the nonbranded CME sessions increasingly developed and supported by many companies in our space. You can do the math yourself on how this generates ROI, but they can drive more advanced discussions with providers and they can lead to increased disease recognition and healthful behaviors.

If we think about it, such ads fuel a value-based care philosophy that focuses on overall quality with emphasis on supporting patients’ needs, healthful behaviors and beyond. For now, virtually all the risk of the shift to value-based care rests on the physician and health care providers, so wouldn’t it be great to see pharma pitch in with a strategy that has ROI for both the company and the patients they depend on?

Ads that emphasize screening and diagnosis, adherence and healthful behavioral change all would make taking a medication a whole lot better for the patient from the quality of life perspective. Many of the big pharma companies have web sites dedicated to these efforts but one glance at them tells you these efforts drastically pale in term of the resources fueling them compared to the TV ad budgets.

I did a little Twitter poll asking my followers if they were in favor of DTC drug ads, disease awareness ads, both or neither and to no one’s surprise — at least among those who follow me on Twitter — there was little support for DTC drug ads (6%) yet solid support for disease awareness. I don’t, however, foresee a ground swell in the federal government to support my wishes at the moment.

I have an idea. What about a deal where for every dollar spent on DTC ads of a specific drug, a given company would have to spend similarly on ads that favor the public’s health in an unbranded way? A licensing fee of sorts to invest in the public good? Please write to me and tell me why this is a nonstarter.

Finally, I hear through the internet that a mandate is forthcoming that will require DTC drug ads, including our biologics and similar agents, to state the “list price” (whatever that is) of these drugs! I can’t wait to hear my patients’ reactions when they hear that their drug “costs” for the year will be as much as a Range Rover. What’s your take? I’m eager to hear your thoughts by e-mail at calabrl@ccf.org or on Twitter @LCalabreseDO.

Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.

One of the best parts of penning my monthly editorials for Healio Rheumatology is the opportunity to let the spirit move me on occasion. This month, direct-to-consumer advertising of drugs — and in the rheumatology world, that is largely biologics and biologic-like agents — has finally arrived.

What follows may sound somewhat random given that I am no expert on this subject; however, as a qualification, I will state that I do watch the evening news with my wife and we often have a mini-lottery on what drug will be featured in the next commercial (which I frequently win).

Leonard H. Calabrese, DO
Leonard H.
Calabrese

With this background, let’s first start with some facts: direct-to-consumer (DTC) advertising is big business. In 2018, pharmaceutical companies in the United States spent $3.7 billion on television advertising alone — and much more if we included other media! Secondly, it must be noted that in the entire world only the U.S. and New Zealand permit such advertising; I’ll let someone else explain the New Zealand angle. Thirdly, these ads must work as no company would invest this much money unless there was some clear return on investment (ROI).

Given these facts, there are a number of potential upsides I can see, namely that some patients may feel better informed and empowered by such ads; however, the declarative knowledge that patients acquire remains in doubt. These ads may also stimulate discussions with health care providers, which I have witnessed firsthand.

But what about the potential negatives? To start, I would say that meaningful messaging about complex therapies is difficult, if not impossible, to convey in the span of a TV ad. While some of the messaging is indeed empowering — medications offering hope and patients taking control of their disease — I don’t think anyone would admit that the adverse event profile is reasonably conveyed. Muted, monotone delivery during pictures of joy and beauty are not really optimal.

Ask yourself: Would you explain potential adverse events to your patients like this or would you be satisfied to hear them delivered this way? These ads also have been criticized for emphasizing imagery (happy, happy people) and misrepresenting statistics, which can be misleading at best.

There is however one kind of DTC ad that I personally like, which is referred to as “Disease Awareness” in which no drugs are mentioned. I particularly like the Gilead-sponsored hepatitis C virus ads. These ads are analogous to the nonbranded CME sessions increasingly developed and supported by many companies in our space. You can do the math yourself on how this generates ROI, but they can drive more advanced discussions with providers and they can lead to increased disease recognition and healthful behaviors.

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If we think about it, such ads fuel a value-based care philosophy that focuses on overall quality with emphasis on supporting patients’ needs, healthful behaviors and beyond. For now, virtually all the risk of the shift to value-based care rests on the physician and health care providers, so wouldn’t it be great to see pharma pitch in with a strategy that has ROI for both the company and the patients they depend on?

Ads that emphasize screening and diagnosis, adherence and healthful behavioral change all would make taking a medication a whole lot better for the patient from the quality of life perspective. Many of the big pharma companies have web sites dedicated to these efforts but one glance at them tells you these efforts drastically pale in term of the resources fueling them compared to the TV ad budgets.

I did a little Twitter poll asking my followers if they were in favor of DTC drug ads, disease awareness ads, both or neither and to no one’s surprise — at least among those who follow me on Twitter — there was little support for DTC drug ads (6%) yet solid support for disease awareness. I don’t, however, foresee a ground swell in the federal government to support my wishes at the moment.

I have an idea. What about a deal where for every dollar spent on DTC ads of a specific drug, a given company would have to spend similarly on ads that favor the public’s health in an unbranded way? A licensing fee of sorts to invest in the public good? Please write to me and tell me why this is a nonstarter.

Finally, I hear through the internet that a mandate is forthcoming that will require DTC drug ads, including our biologics and similar agents, to state the “list price” (whatever that is) of these drugs! I can’t wait to hear my patients’ reactions when they hear that their drug “costs” for the year will be as much as a Range Rover. What’s your take? I’m eager to hear your thoughts by e-mail at calabrl@ccf.org or on Twitter @LCalabreseDO.

Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.