Sawbones: A Marital Tour of Misguided Medicine - Direct-to-Consumer Advertising

Episode Date: May 4, 2021

For MaxFunDrive 2021, Sawbones is talking about gross medicine of a different sort. In the United States (and New Zealand) we see a lot of those commercials for prescription medicines with jaunty names and a full minute disclaimer at the end. How they came to be the norm here is a complicated history of bad medicine and the shifting of credence among doctors, patients, and pharmaceutical companies.Consider becoming a supporter of our show: www.maximumfun.org/join/Music: "Medicines" by The Taxpayers

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, a day for our kids. Hello everybody and welcome to Saw Boom. It's a Marleter of Miss Guy of Medicine.

I'm your co-host Justin McElroy. And I'm Sydney McElroy. And we're broke. That's right folks, the Max Fun Network is broke. We're ruined. No, that's not. We're not. We're not broke.

And this is the time of year where you get to say, nah, I'm not going gonna let the network cancel maximum fun The the higher ups the big cheese. This is the way to fight the man the big cheese the man wants to shut us down This is a pirate signal you're getting right now and the man wants to buy it and shut it down and turn it into just another Channel fall of are you tired of everybody telling you what to say? What to think? Who to be?

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We've got an incredible variety of audio waiting there for you. There's better, more gifts, better gifts, plus that gift, all gifts, maximum fun, as you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about.

As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about.

As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. As you can tell you about. This show, I know that this episode seems a little commercial, but we're going to balance it out with this episode. It said, what are we talking about? Commercials. I tell the truth. I didn't plan that this episode would come out this week. It's sort of oops, But I think it's good. I think it's good.

So traditionally for Max Fun Drive, we try to do something that might be like, I don't know, I usually lean into the gross out parts of our show I think. Don't you think that's usually where I? One for them. Right. One for the people.

And I think this is something a little different. I guess it's gross in a different way maybe. Some of the things we'll talk about with the American medical system. I think it can be gross in a different way. Not so much like, you as like, that kind of thing. Gotcha.

But we get a lot of questions about prescription drug advertisements. Specifically, I get a lot of questions about that from listeners outside of the US since it is globally speaking, a very rare thing that we have those. And so I thought it would be an interesting, maybe a little controversial, little spicy topic to talk about.

I don't know, big pharma listens. Hey big pharma, if you're out there, I'm sure they're paying people to listen to this pirate signal. I bet that's what they do, I bet they are. Because it's a sticky issue. It's not a straightforward, if you go into the history of like,

why do we do this? So in the United States, if you live outside the United States and New Zealand, which are the two countries on earth that do this. So if you're in New Zealand, you know, exactly what I'm talking about. If you're in the US, you know, outside you're going, now what, what is this? We run advertisements on whatever, whatever form of media you would like to advertise on for prescription drugs. So medications that you could only get with a prescription from a doctor, which seems odd, right? Like, if you just take two extra seconds to break that down,

why would I advertise something to you, Justin, that you can't go get on your own? There's an intermediary, you would have to get permission approval, you know, buy in from in order to. And in an intermediary who ostensibly would know like better than the company who is talking to you about whether or not you need this product. Exactly. So it is a good question. I know we've gotten this a lot over the years. Jonathan most recently wrote an email and kind of bumped it to the top of my list, which

is a good reminder. If you've emailed me before, I say me, us, and we haven't done your topic. It never hurts to email again, because sometimes it bumps it to the top. We're in peace, our inbox. Oh no, I check, but I miss things sometimes, and then this bumped it to the top of my mind.

I read a great article to help me sort of structure this, and I read a lot of different sources, but I did want to cite a history of drug advertising, the evolving roles of consumers and consumer protection by Julie Donahoe, which was not a, it was more about population health and health policy as opposed to a medical specific journal. But it was an interesting perspective to look at the history of this. So I can tell you that on the physician end, we complain about these a lot. I would say that generally speaking,

most physicians are not a huge fan. Because once there is a drug advertised on TV, it is very common that someone will come and ask me about it. And what's hard is that our visits, and especially if you live outside the US, this might not be as intuitive. If you live here, you know, you're only a lot of so much time per visit, right, which I have railed against and I am totally not for, but that there it is. And if I have to use a chunk of the visit, trying to discuss... Or with some home. Well, trying to discuss why maybe I know immediately like, oh, actually, this wouldn't be a good fit

because that's not exactly what your diagnosis is or you have a contraindication or you're already on something that works fine and switching to this new product has no advantage. Doctor stuff. All the other things, or a lot of the time, frankly, you're on something that works fine. This might work the same, but it will cost so much more and there's almost no way that your insurance covers it at this point.

So I'd be switching you to something you probably can't afford, which means you wouldn't take anything. And then we'd all be worse off. Because that's the other thing. If they're advertising it on TV, it's usually something new. And maybe colorful. A lot of times they have big bold colors, like Viagra, remember that? Yeah. Or the blue. The purple pill. Or it was the rubber box.xium, yum, yum. There are some very pretty pills out there. So what is the advantage then of advertising directly to the consumer?

You can't go order it. You don't pull up to a doctor drive through window and just order what pills you want. Well, actually that does happen, unfortunately, but that's a whole other episode and problem. And if you want to know more about it, please come to Huntington, West Virginia. Anywhere in West Virginia, really, we can fill you in on that anytime. But I think there are probably two answers to this question.

The first, and it's really obvious, and I don't want to spend a lot of time on it. But why would pharmaceutical companies spend tons of money to advertise directly to patients. Because then the patients will ask for the money, it bills, and then maybe they'll get them, and they'll sell more pills. It must work, right? Yeah, well, they wouldn't be doing this. They wouldn't continue to do this if it didn't work. That's the reason you choose any specific marketing strategy, right? Because it works, and so you do it more, and it works more, and so you keep doing it. If it doesn't work, you wouldn't keep doing it. The second answer is more interesting. Why is this allowed? And how did we get here? It's good for the pharmaceutical companies, obviously. It must be because they keep doing it. But who decided that it was good for patients,

that it was good for the population, like the individual and society as a whole, who thought it was good for the medical community, who decided this was the right way to go, because obviously most places on earth decided it wasn't. So why did we choose a different way? I guess money, if I had to guess, I don't mean to get ahead of you. It's a little more, I mean, I'm not saying that money isn't a part of this. We've already covered the fact that this makes money, but let's get into the other side of it. Okay. So we got to go way back to the beginning of the 1900s.

Delidie, delidie, delidie. So the idea of a medicine being a prescription drug or an over-the-counter drug was not a thing at the beginning of the 1900s. All medicine, you could either access a few different ways. Either you would just go buy it on your own, right? Just go to the pharmacy, go to the store, go wherever buy it, maybe buy it from a traveling salesman, from a medicine show,

from somebody in the community you trusted. Maybe there was a pharmacist or a doctor or a midwife or a nurse or someone locally that you trusted, you bought it from, maybe you made it. You might get a prescription from a doctor. That did happen where you went to a doctor complained about something and the doctor wrote something out and said, take this to the pharmacist

and they'll usually it was something to compound, something to make. So they'll take this over there and they'll make it for you. But it wasn't necessary. That same thing that you had on that paper, the next time you were sick, you could just go directly to the pharmacist and ask for it. You didn't need that prescription. It was just sort of a shorthand communication, right? But anything you wanted, you could get. And doctors were in the business of dispensing drugs back then, too. So you may just go to your doctor saying we're sick and your doctor would give you a shot

of something or pills or whatever. So it's important to understand that at this time, this really corresponded with the way people thought about medical treatment. There was very much this sort of general attitude in the US that self-treatment was an American value. Which is, from what I know about that time period, was probably a question necessity as

much as anything else because we have not nearly enough doctors to go around. So a lot of people were sort of practicing on their own and figuring it out on their own. That's exactly where this idea, you know, would probably have generated from. We went from no doctors, except for whoever was willing to come here, come over here, to a wide variety of various types of practitioners practicing all sorts of forms of medicine. We've talked about many of them on our show, some which made more sense than others, none of them which made complete sense yet, right? To the idea that we do need to train doctors in a certain way, but at the same time, we're still practicing outdated forms of medicine because the scientific method is just being perfected and evidence-based medicine is just coming into being.

So even once you have like, okay, we're at a point where that's a doctor, I know they must have to be a doctor, you must have gone to school and learned these certain things and we formalize that training. That doesn't necessarily mean that what they have to offer you is very helpful, right? As part of where all these other sort of alternative forms of medicine came from was this understanding that if you went to the doctor, you were just as likely to be killed as healed. Yeah. Right. So all of this gave rise to a lot of people just want to stay out of the whole mess. And we're like, you know what, I'll just take care of myself. Yeah, I figured out. Yeah. And they had a lot of folk knowledge. Again, there may have been some local people

who had some sort of formalized training that they trusted, but they basically cared for themselves. Now, there already existed the idea that there were medicines that were different from others, that there were two groups of medicines. Meaning? Back in 1820, there were 11 doctors who sat down in Washington, D.C. and created the U.S. pharmacopia. And in it were like, that's where they put the drugs that they said, we think we have some evidence that these actually do something to try to distinguish them from all the patent medicines out there that made outrageous claims, but didn't necessarily do anything. They called the drugs that were in this pharmacopeia,

the ethical drugs. How so? That was the name they gave them. They're ethical to prescribe. They're ethical to advise a patient to do. They're ethical to take money for these because they might actually do something and not harm the patient.

Yes, as opposed to patent medicine, which is, so, and if you, if you wanna think about it, ethical drugs would become prescription drugs Pat and medicines would become over the counter drugs. Okay. It's not a one-to-one, but that's it's close Because some things would cross over But to imply that most of the counter drugs are as fake as bad medicine. No, no I'm not implying that at all, but generally speaking the idea that you you needed to Well, there were certainly medicines

that would have been considered ethical because they were proven to work that eventually would not require prescription because they were not deemed so dangerous or harmful or complicated. You know what I mean? That you would need a doctor to prescribe them. We've seen that in modern day times,

a medicine that was once prescription only that becomes over the counter. Loretta Dean, right? I remember that. Clareton. Clareton becoming some of the... Yeah, next CM, we talked about that already. A lot of medicines that were prescription only, and then eventually enough testing indicated that this is probably not necessary. The consumer can use these safely as opposed to the patient in your office.

But again, no script was still required at this time. in your office. But again, no script was still required at this time. So the medicines were marketed, if they were marketed, direct to consumers by default. Right. Because that's, you know, that's about it. Yeah, that's an extent. And so, and so again, you have the flyers and the ads in the newspaper and that we've talked about the calendars and the ladies journals that would go out in all the different forms of medical advertising, the medicine shows, the patent medicines were much more heavily marketed than the ethical quote-unquote ones, the medicines that doctors are supposed to use. And the American Medical Association was not a fan of the system.

They didn't like any of this because they're watching all these drugs be advertised. They're not the ones that they want doctors to prescribe. They're all the other ones, basically. And they made false claims. I mean, that's the other part of it. They would encourage patients to go buy stuff that probably just didn't work, but also might harm them. And was against what the doctor advised.

Right. I know we're headed towards though. I know my timeline. I at least know this. They were hurtling towards the FDA, right? We are hurtling. Actually, that is just that is where we are back. 19 or six. Where that office of my? We're in 1905. Okay. Oh yeah. We're in 1905. You could smell it just around the corner folks. Don't worry the FDA is coming. The AMA, the American Medical Association, started promoting the ethical meds, the ethical medications that had been tested to some extent and basically said, we are not going to let ads for these patent medicines run in our medical journals anymore.

So like, maybe you have access to the public, but you don't get the docs. The docs, the journals that the doctors read are only gonna have ads for ethical medicines, if any at all, but none of this patent medicine stuff. And also, doctors were encouraging you not to recommend any patent meds anymore, which doctors would have been doing. Sure. And so at this point, you have this sort of split.

The doctors are kind of separating away from the rest of the public and saying like, all those meds you're using and that you are selling they're bad and wrong. And these are the real ones. So what would come from that post-era? That's been a hard sell. It was like you're thinking about like

one, the cultural thing too. Some of the auto's patented medicines were making you high. They were getting you, so like you are beyond just like mentally invested in them, you are maybe addicted to them. Yeah. And also, PS, the patented medicines salesman, from again, this is just based on stuff that we've read and covered in research, but like the patented medicines salesman were, you

know, shifting or not, were the ones who were like in your community, bringing the meds to you, widely available. Yep. And also maybe they had like, up singer and a stage show. So I would put you on stage and pull your teeth out for you. Yeah. How does medicine can be with that? Well, and that was, you know, as we get into 1906 when the pure food and drug act is passed, the creation of the FDA and the idea that we should regulate drugs, curb false claims, and initially just like put the ingredients on your label, right? Like that was the big thing. Yeah.

You just have to say what's in there. If it's opium, you got to say it's opium now. That, that was the initial thing that happened. And this does not do a lot of what our laws do today, right? Like they weren't saying you had to prove it was safe. They weren't saying you had to prove it was effective. They were just saying you got to put what's in there on the label and we're going to start to try to regulate drugs and do this in a systematic way. And we are also are going to have some teeth to go after the people who are breaking the laws. But it wouldn't be until the 30s that we would and into the 50s that we would actually see the beginnings of what would lead us to direct consumer advertising.

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Okay, so where were we, where were we said? It was 1906. We passed the pure food I got. That was great. I didn't undo that. So that ad was actually from 1905. We passed the pure food I got. That was great. I didn't undo it. So that ad was actually from 1905. But that wasn't enough. In the 30s, a hundred people tragically died from taking a formulation of self-anilamide, which was an early antibiotic. And that really inspired a lot more

action on the part of regulatory commissions on the part of a government. Along with multiple issues like that, they were still battling all the patent medicine advertisements that would make claims that weren't true or could harm people. And so from the 30s, 40s, 50s, we see this sort of progressive regulation of this industry and creation of trying to catch up basically with what they were already doing. They also began to regulate the two groups of drugs differently. So drugs that were meant to be sold directly to the public, they started putting restrictions

on exactly like what do you, if you're going to sell this direct to the consumer and you don't have to have a physician go between, you have to include the ingredients, but also the side effects, the dosing instructions, the contraindications, all of this stuff has to be clearly outlined and available and written in a way that a non-medical person would understand it.

Right? Drugs that were meant to be prescribed by a doctor didn't have to be so tightly you know, regimened because the idea was, well, the doctor has medical training, so they don't need all of that on the package. They can recommend it to you based on their medical knowledge and you'll take it because they told you to, but you don't have to have all that, you know, now all the stuff you get with your prescription medicine, you wouldn't need that back then because the idea was, well, the doctor told you to take it so it's fine. You don't need to know all of that. Just trust the doctor. And it was all in technical jargon, too. They didn't have to put it in lay people's

speak because it was for the doctor, not for you. Also, the FTC was given the authority throughout the mid-1900s to crack down harder on the false claims. So the advertising piece started to be addressed to ensure that consumers were given all the info they needed, what the drug actually did. And finally, in the early 50s, it was decided that the FDA would regulate that the one group of drugs that were now called prescription drugs

as opposed to ethical drugs, right? And you could only get those from a doctor. And then as it's true today, over the counter meds kind of fall outside that purview. But they are still, you know, they still have to watch what claims they make in advertising, right? You know, the FTC has very strict rules

where you can't make claims that you don't have backed up by evidence and all that kind of thing. And so they're still regulated in that way. But all of this shifted the focus of drug companies' marketing efforts. So up until then, really the only medicines that were advertised were patent medicines. Well, by the 1960s, 90% of drug company ads targeted physicians. It's wild if you think about it today. I mean, they were the agents of the products, right? They were the gatekeepers.

Yeah, everyone's you want to reach. If you're making and selling drugs, the only way you can get it to a patient, if it's one of these prescription drugs, is to get it through the physician. And the public didn't mind that so much at this point. If you're looking into like the post-World War II era, physicians were really at the peak of their popularity in this country. All downhill from there.

I mean, this is going to be the case. So in the post-World War II era, a lot of people sort of said, you know, self-treatment was the way of the past. The future is to trust in experts and scientific opinion and go to your doctor, ask him a question, whatever they say must be right, because they're learning. It's also part of a groundswell of celebration of like science

and a passion for science that was like, I mean, I tried to, a lot of it, atomic development, you know, science helped us win WW2. So we should be trusting in science to like make our dinners and, you know, the home of the future was always very science-based. All that stuff. So you went to your doctor and your doctor was an expert and they told you what to take and you thanked them and left. And the pharmaceutical companies started sending out what they called then Detailmen, which again were like the precursors

to pharmaceutical representatives who would inform and charm the doctors. I mean, doctors interviewed in the time period said that these people were their friends. They're trusted confidants. I mean, they were really on close terms with these pharmaceutical reps whose job was to get them to prescribe the medication,

but they also trusted them for information about the drug. They were the experts on the drug. So that's where they were getting the information about it and had the incentive to prescribe it because of that close relationship. I mean, they're kind of like lobbyists, right? I mean, basically, like the metaphor, like they're basically lobbying. In a sense.

It's the same idea, the fostering relationships to attempt to persuade, you mean? Well, it's, I mean, that's always the tough part. And I mean, this is like, gosh, this is the recurring theme when you talk about the system of medicine in this country is that the idea of I made this drug, and I know it works, and I have all this research to back it up, but I wanna employ someone who is really good at communication, who has great communication skills, to go tell the doctors about it,

so that they understand, because my expertise is the lab, your expertise is people, go talk to people and tell them why this works. That makes total sense. I don't, I mean, I think anyone would agree like, okay, yeah, I see why you would do that. But once there's all the financial incentive that there is in pharmaceuticals and in the medical industry in general, the trust starts to break down, right?

And what you believe and what you feel like is legitimate really changes. And, and I mean, we're seeing the beginnings of this problem, the backlash that would happen to this era, I mean, it was inevitable, right? So the burden of explaining all those risks and benefits and side effects and contraindications, all those contraindication is a reason you couldn't take a drug by the way. If it's contraindicated in you, it's because of, you know, something intrinsic to you or a disease you might have or whatever. It's not it's not a proof for you. It could harm you. So basically this was all left to the doctors. Because like I said, you didn't have to put that package insert in there anymore. Yeah. So if communication broke down, if the doctors didn't do a good job of explaining

it to you, if they just said, as was the fashion among not all, but certainly many, do this because I say so because I'm the doctor and I know. If you got sick or you had a bad side effect, who did you blame? Who did? Yeah. Who did you feel misled by? Exactly. And if you look at a case like Philidomide in the 1960s, which a lot of people prescribed and did cause birth defects, the FDA and now consumer groups were being formed, that were looking at this system a lot more critically, and saying, okay, something is going wrong.

Either the doctors don't know enough about these drugs or the doctors aren't telling patients enough about these drugs, but we are still not getting, you know, the clear system we want, the very open, transparent, honest thing that we thought we were going to achieve. So first came package inserts. When you get a prescription medicine, it comes with that big thing.

That big thing. Do you ever read that big thing? No, I don't read that big thing. Yeah. That big thing. Do you ever read that big thing? No, I don't read that big thing. I may do it doctor. It's one of the perks. Said what I do with this. Which hole said one of my times?

I personally, this is, I know this is, they're gonna be a lot of people in medicine who are like, what? I loved, you always have some patients who will come to you after you've prescribed them something, and then you think you've done a really good job of talking to them about it, and then they'll come to you to their next appointment them something and then you think you've done a really good job of talking to them about it And then they'll come to you to their next appointment and they'll have the medicine still in the packaging in the pharmacy bag with all the stuff with it

And they'll have highlighted certain things and want to talk to you about it before they take it I used to love this center because then you have to discuss like why it's less than one percent that they've listed this one thing And why you still think it's an okay, and let's talk about it. I just actually love those. But anyway, but that's when that started to become a thing. But that didn't suffice because at this point, the role of the doctor in society had really changed. A lot of these advocacy groups had been had begun to spring up demanding more autonomy in decision-making. The idea of paternalism. And if you think about what time period we're in,

we're moving into the late 60s and to the 70s. So the idea of trusting the system, of trusting the man, all of that had broken down. And what broke down with it was your trust in your physician. Really through the 70s, the patient physician relationship continued to degrade to an extent.

And I mean, I'm not saying that it wasn't part of Dr's fault, you know. Sure, yeah. These, it's tough for you to talk about a system like this. Like everybody's, even if you have individual people trying to do the right thing, like we have a system built to do this. And it's tough to push against it. And every time there was a highly publicized case of a doctor who prescribed something or wouldn't do something or did something that was seen as wrong, you know, then that trust

just went down further. And eventually you see the creation of ethics boards whose job it is to oversee doctors because we can't trust doctors to act ethically, which is fascinating when you consider that the root of all this was we want to prescribe ethical medicines. And now we need an ethics board to watch us because we can't be trusted to behave ethically, which is already a far cry from, I would say, our Hippocratic oath. But by the... Hypocritical, I guess.

Just a black azinger. I guess hearing this today, hotchi, matchy. Hippocratic oath, but by a hypocritical of like a just a little singer. You're in this they hotgy matchy. So because of all this, as you can imagine by the 80s, the pharmaceutical companies had noticed. They had noticed that doctors just ain't who they used to be in the public eye. Doctors are hot anymore. And so they tried some things that like a couple unusual things at first,

like having some people talk about a new product on a talk show, and they noticed that there was an uptick and sales, like, hmm, that wasn't the doctors, probably. What are what that was all about? And then there was a Pfizer ran some ads for like disease awareness, without mentioning what drugs treated them, but would just have like the Pfizer logo on there.

So that like you could put two and two together, like well they're running an ad for diabetes. I have diabetes. This is Pfizer. Maybe there's something, you know, to get people to go in and ask their doctor about it. And then finally a couple of companies went for it. There was a pain reliever called Roofin.

pneumonia vaccine was advertised direct to consumer or a flex was another arthritis medicine that was advertised by Eli Lilly, straight to consumer. Or a flex was actually probably a good test case because it got so popular so fast that so many people were prescribed this medicine that they realized within five months that it had terrible side effects and they had to pull it from the market, which of course is bad, but the signal it sent to the advert, you know, to the marketing arms of these pharmaceutical companies was. But phase open.

This works. Yeah, time to come get your scoop. So in 1983, very quickly, the FDA said, wait, wait, wait, let's stop this. Don't do this anymore. They put a moratorium on direct-to-consumer ads and said, we've got a root. Well, we don't know if we like this. And that wraps it up folks that thank you FDA for doing the right thing. Maximumfund.org for its last join is the URL. Thank you so much for listening. That is obviously not the end. You have seen pharmaceutical ads on television this week. I think I have misremembered. I was alive at 83.

I was just remembering asked for one. I was a toddler. I think the problem is that when this, there is a period here from 83 to 85 when this moratorium was in place where you had like everybody was kind of in agreement that this isn't a good idea. They have pharmaceutical company CEOs on the record in this time period saying direct to consumer advertising is probably not a great play because consumers don't know enough to make this decision.

They just don't, they don't understand these drugs, they don't understand medicine, they can't safely evaluate whether that medicine is good for them or not, and they gotta get it from a doctor anyway. And you can't, that's the thing. You can't because if you could, it would be, they wouldn't be prescription.

The AMA didn't want it because, and again, like the AMA is what we've seen as acting for control, which whether or not that's true, it's hard to evaluate when you're just an organization. And at that point, again, doctors were still not popular. So it's like, well, of course, doctors don't want it. They want control. And it didn't help that we had this relationship,

like we're all cozy with the drug, like none of this helped our image at this point and so by 1985 basically the FDA said like well Okay, I guess you can do it because honestly We really don't think it'll go anywhere. We don't think anybody will do it It's not gonna be effective most people aren't gonna pay attention because they're not gonna understand so they won't listen to them And it'll probably die off pretty quickly This was just this was genuinely what they thought in 1985. We'll let you do it because nobody's gonna do this. Just so I'm clear though, we're not talking about,

in this time period, we're gonna talk about all pharmaceuticals, we're talking about prescription drugs. Cause I know that there are very old ads for private, Bayer and... Oh yeah, no, all the, all the, yes, plot, plot, fizz, fizz and all that. All yeah, all the, yes, plot, plot, fist, and all that, all the over the counter meds were still, I mean, they were again, subject to the Federal Trade Commission.

Like they couldn't say whatever they wanted, but like, no, that was still happening. This was the idea that a prescription drug could be marketed to a consumer. And in the 90s, this is when, this is when things took a turn. First, you get the rise of managed care organizations, the idea that we could maximize profits in medicine

by controlling certain aspects of the medical. And this is really where you see this transition from like doctor patient to seller buyer. And then, I mean, not that doctors felt like they were selling medicine, but like the organizations that they were part of were selling medical care and you were consuming it. I mean, you see the rise of the consumer over the patient. So at the same time that that was happening and people didn't like that. So a rhodod trust in the medical system even further. Actually, by 1990 less than a quarter of patients had faith in medical leaders, less than a quarter.

And this probably did in that. There's probably nobody after this. And also, you get like lifestyle drugs showing up, things like Viagra and Rogaine and stuff. We're like, as part of a routine checkup, I'm not going to look at you and say, are you worried about a rectile dysfunction? It just isn't on my list. And so, unless you tell me, it might never get addressed. Which I do frequently,

but you blow me off, I don't get it. So, advertising that directly to the consumer made sense because it encouraged you like, well, maybe I should tell my doctor about this because there's a medicine for it, right? It was awareness that there would be a treatment. And these are the ones that what I love and the ones, and these are probably a little bit more modern.

So I don't want to get heavy, but like, the ones who are like, don't you think it could be a little bit better? Like, you didn't know that this is a problem before, but like, maybe it is, like the low T stuff. Like, hey, is your T-Lo? I'm like, I don't know, man, I never thought about it. Well, maybe you should start thinking about it, Jamie.

Maybe that's the one solution, the thing that you need to fix everything is your T. Well, and I think that's the problem is that as we, as we're gonna move into, a lot of these drugs can be painted as a general solution for your life as opposed to, this is a medicine that addresses a very specific thing. There is such a thing as low testosterone.

There are symptoms associated with that. Supplementing testosterone can help in those specific symptoms, but it is painted as like, did you just lose your vigor? Take testosterone. And that is not. Are you lacking them? Or like energy.

And it's like, well, there are a million reasons. I mean, I'm tired all the time. Not sure. Like, there are a million reasons. And so it, but it does paint this picture that whatever your problem is, this is the solution. But they had to be very careful. See, before they got there, and that's where we are.

We're at this point where like, they're trying to figure out how can I follow the instructions because they still have to include all this in their advertising. Like, if you're going to put it on TV instead of in a magazine or in a newspaper, you still have to tell everybody about all those side effects. I love that. When it's like 15 seconds of ad, 45 seconds of this is really small. You're going to be like, well, you go into the end. it's not really contraindicated. And then if you want more information, they used to give you a toll free number. Now they give you a website. This is really in the 90s,

this is when this became possible. So, so they're at this point where in the 90s, the pharmaceutical companies are starting to realize that hey, maybe direct to consumer is the way to go because we can get patients to start asking their doctors for these drugs. What if we try it and see if it works and see if, you know, we see an uptick in sales from this? And it was the right time to ask because patients were demanding, we want our rights, we

want our autonomy, we want to be part of this. We're not here for your experimentation. We want to be part of the decision-making process. We want a partnership with our physician. We don't want paternalism, that's over. Don't just tell us what to do. I want to partner with you. And at the same time, you had this rhetoric on the right about the FDA

as a job killer. They're trying to overregulate you. They're trying to overburden some all this stuff. So out of all this, I mean, also doctors opposition was just seen as like, well, yeah, you just want to control everything, don't you? So, they started advertising direct to consumer. And in 1997, this was challenged like, well, but we said that you had to like provide all this adequate information about the drug. And the way they got around that was like you see in the farm commercials where they say, you know, side effects include

everything on earth and linking to something where you can find out more information. As long as you provide that, you've you've fulfilled the the law as it has written so far. That's all you have to do. So they do that and direct to consumer advertising has grown to around $6 billion. It's pharmaceutical companies spent in 2016. Why are they spending billions of dollars? Because it works. Because it works. Patients are more likely to ask for a drug they've seen on TV.

Doctors are more likely to give it if the patient asks for it. If you come and ask, no matter where you saw it, if you come and say, I want this drug, I am now statistically more likely to give it to you. Whether or not, hopefully I think it's the right choice, but whether or not, for every thousand dollars spent on direct-to-consumer advertising, 24 patients get a prescription. And a drug with an ad is seven times as likely to be prescribed as one without. There are tons of stats. I mean, like there are endless statistics on why this works. Of course it works. That's why they're spending billions of dollars on it.

So what's the answer then? Because the way that this has grown. Yeah, it can be honest, said the picture you've painted here is pretty bleak. Well, the way that this has grown is that the reason pharmaceutical companies are doing this is because you, the patient, have a right to this information. We have a history of doctors not being very good about telling you everything. We can't trust them to tell you everything.

So you need to have this information. You need to be empowered so that you can go ask your doctor for the thing you need. And the tricky thing is that the truth is somewhere in the middle, right? Like, yeah, I don't agree with paternalism either. I was taught not to practice that. I teach my residents and students not to practice that, meaning you don't tell your patient what to do. You sit down, you talk, you help them figure out what's going on, what are the, what are your

diagnoses. And then you come up with a plan together, based on your area of study and their life experience that works for them That is the heart of the interaction. I really don't see where a commercial can improve that But it's so tricky to sell it now because What I am saying is the voice of you know the AMA of old that said, oh, you can't understand this. I know your body better than you know your body. So listen to me, not you.

And it's not even a clear line in the culture war because like, I feel like a distrust of the medical system is something that is sort of agnostic of your political position. Even though it's, you probably come to it from a very different thing, but for every person who's like, you know, Republican who like just doesn't believe doctors because they have a lack of faith in science or what have you, you have a Democrat who's like, I believe in, you know, a homeopathic treatments and natural treatments.

And like that distrust is not something that it's like going to be fixed by having a, you know, a certain color in the in the government. And the problem, the root of it. And I mean, I'm sure there are people who are smarter than me who could figure out how, like using the law, we could untangle this and fix it. But the root of it is that there are people in the system who are good and honest and trying their best to help other people, right? Whether we're talking about the healthcare providers or we're talking about people who are working in labs and creating these pharmaceuticals. I think we've seen this in action in the last year with the vaccines.

There is great good that can be done by the people in this system. But the system around it, which provides so much money for some people, not all just some, is crushing that. And it's preventing a lot of people outside the system from seeing how it could ever be any good. So you distrust the doctor because the whole medical system is corrupt. And I'm not disagreeing that, I mean, a capitalist healthcare system by default cannot provide good care to all people. It cannot.

And it has been proven all over the world that there are better options for the healthcare system we have, and we just don't do it. In my correct city, in my realization that I've just had in this moment, that you do not think a direct consumer advertising as a problem that needs to be fixed, but rather a symptom of the disease

that is capitalist medicine. I think that's a good way to look at it. I mean, I really do because I don't, I believe in a well-informed public too. And that's what the pharmaceutical companies would tell you. We want patients to have the information and the right to make their own decisions. Well, I agree with that statement wholeheartedly. What I'm saying is, is that really why you just spent $6 billion running ads for these meds to them?

No, no, it's so that you'll sell them at any cost necessary. And that cost is really high if we're talking dollars, by the way. But yeah, I agree. I think it's a symptom of how diseased the system is and how if we had a system where everyone could receive equitable care where everyone had access and could afford it, then I don't think

you would have this inherent distrust. And when you and your doctor, you and your primary care provider, you and your specialist who ever sit down to make a decision, when you and your oncologist sit down to make difficult decisions about your cancer treatment. You don't need that commercial for chemotherapy that I saw on the other day, a commercial for chemotherapy to help instruct you because here's the thing, I'm a family doctor, I don't even know which chemotherapy is best for you. I went to medical school for a really long time, I know lots of stuff. I don't know that. There's no way that being diagnosed with cancer immediately gives you all the knowledge you need to make

that decision. Certainly that commercial won't, but your oncologist did go to school. If you trusted your oncologist and you could form that partnership because the system around us wasn't so broken, then you two could make that decision together. Maybe it's a thing in the commercial and maybe it's not, but the commercial wouldn't weigh into it. But unfortunately, we're at a point where those commercials, you know, some people think it's the only way they're ever going to have any autonomy over their health and well-being. And it's sad, you know, that we haven't done better to show people that there is a way that we can do this without money.

Folks, there is not a way that we can do this without which is to say podcasting, which brings me to one last plea that you'll support the maximum fund network here in our max fund drive, maximumfund.org forward slash join. And you're, I was putting the network really, you're supporting the showsorg, forward slash, join. And you're, I was putting the note, but really you're supporting the shows that you care about, the creators that you care about. Maximum fun is, I'm like a lot of podcasts networks. They say, artists own, audience supported. And that means you allow us, we own these shows. Like, the max fun isn't like an evil conglomerate

that is goblin up our our program, right? Like burdensome regulation. It's a it's a co-op. It's a collective. It's like the beginning of a call the cool part before it gets to the all the weird stuff. But we need we need your support to make that happen to keep these shows free and independent and we really, really appreciate you're doing that. $5 a month gets you hundreds of hours about his content 10 bucks a month. You're going to get a beautiful pen for 20 bucks a month. You're going to be wearing your pinning and be listening to your bonus content. You're going to be sipping some delicious tea.

And what's better than that? I mean, that sounds like an afternoon and a half to me from rocks. I agree. So please, if you can, maximumfund.org, Fordslash, join. Thanks to the taxpayers for using their song medicines as the intro and outro of our program. And thank you to you for listening and your

for support. Until next time, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Maximumfun.org. Comedy and culture. Artists don't. Audience supported.