Chat transcript: Jeff Kahn on drug marketing ethics

August 16, 1999
Web posted at: 2:31 p.m. EDT (1831 GMT)

(CNN) -- Following is an edited transcript of a chat with Dr. Jeffrey Kahn, CNN.com's bioethics columnist. Kahn joined us August 13, 1999, from the University of Minnesota to discuss prescription drugs and direct marketing.

Chat Moderator: Welcome, Dr. Jeffrey Kahn!

Dr. Jeff Kahn: Thanks. Nice to be here.

Chat Moderator: Dr. Kahn, do you think pharmaceutical companies have gone too far in advertising and marketing drugs?

Dr. Jeff Kahn: In answer to the general question, I think the pharmaceutical companies have been overzealous in how they market, leading to misunderstanding and confusion for patients.

Question from Pace: Dr. Kahn, do you feel that some patients are going to be losing the benefits of medication by demanding an advertised "name brand" over a generic or different medication, without realizing the full effects of the medication they are demanding?

Dr. Jeff Kahn: I think it is hard for lay people, like you and me, to understand all the factors that should go into which drugs are best for which patients, under which particular circumstances. So, when patients ask for a particular drug they've seen or heard advertised, it creates a problem for their physician, for the people paying for their drugs, and potentially for their care.

Question from NY_Democrat: How can the pharmaceutical companies in good conscience charge such exorbitant prices for their medications? Can't the physicians offer generic alternatives?

Dr. Jeff Kahn: You'd better ask them! Physicians and pharmacists can offer generics, but when patients see ads for brand names, it creates expectations that those drugs are the latest and best. So money is no object when our health is concerned, right?

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Question from Candyce: What is behind the explosion of prescription sales in the last few years? Is it patient empowerment?

Dr. Jeff Kahn: I don't know that there's been an explosion in drug sales so much as a very large increase in drug costs paid.

Question from NY_Democrat: I think we need socialized health care, in some form. Having 30 million Americans without coverage is just plain untenable. I mean the working poor who don't have any health care, are living below the poverty line, and don't qualify for government health care.

Dr. Jeff Kahn: Of course, you're right, and I agree we need to find a way to assure sufficient access to all. Part of the cost issue is prescription drugs, and like any other business, drug companies want market share. So there's a balance between creating incentives for new drugs and affordable health care.

Question from Pace: Do you feel that the competition in the drug market might actually lead to some benefits? For example, might the competition between two drugs that have similar effects drive the cost of both drugs down in the spirit of competition?

Dr. Jeff Kahn: Competition in the market helps create incentives for new drugs but also leads to the kind of misleading advertising I mentioned in my column. The FDA is very concerned that such competition in the consumer marketplace will lead to problems. So they have suggested we go back to advertising of prescription drugs only to doctors. What do you think of that?

Question from Pace: Personally, I think that is a good idea. It appears that, at least from my perspective, the problems outweigh the benefits.

Dr. Jeff Kahn: But then we lose the value of consumers controlling their own health care. An educated consumer is a good thing, so long as the education is objective.

Question from Candyce: I think patients should know what's available and work with doctors to get the information they need to make good choices for themselves.

Dr. Jeff Kahn: But there's no way for us all to research all the thousands of drugs on the market. We all know about Claritin and Viagra, but that's because they advertise those drugs on TV and in magazines. So are we getting good information?

Question from Abby: Doctor, are there any studies being done now studying the issues of drug advertising and patient well-being?

Dr. Jeff Kahn: Good question. Not that I know of. But in talking with my colleagues in the medical school here, there is a much bigger difference in patient awareness and requests that they think come from both advertising and the Internet.

Question from Candyce: How about drug advertising on the Web? How much information are patients getting from doing research on the Internet?

Dr. Jeff Kahn: Exactly. There is a huge effect from the Internet. But if you think that mass-market advertising can be misleading, the Internet is exponentially worse. There is very little way for consumers to tell if the information they read on the Web is reliable. So it's a powerful tool, but without regulation or oversight.

Question from Pace: I know that you can order drugs, for example, Viagra, over the Internet without too much hassle. When drug companies are advertising their products on mass media, people are then informed that a drug will do a certain thing FOR them but might not realize what the drug might do to HARM them. Then they decide to bypass their doctor and order the drug directly over the Internet.

Dr. Jeff Kahn: Buying drugs on the Internet is a dangerous problem. The problem is that the United States can't regulate sales from overseas, where the regulations are much more lax. Buying and taking prescription drugs outside of a doctor's care can't be smart.

Question from Lucy: Who started this trend of drug advertising? And if companies are making so much money off it, will they ever stop? All I can think of is Allegra!

Dr. Jeff Kahn: There isn't one example of who started, and in fact, there has never been a formal prohibition on mass-market advertising of drugs. But it's exploded in just the last five years.

Question from NY_Democrat: Doctor, doesn't the aggressive marketing of drugs such as Viagra combined with the ease of getting these drugs on the Internet lead to the abuse of prescription drugs by people who have no real need of them?

Dr. Jeff Kahn: I don't know that anyone has studied that question, but I can only imagine the answer is YES!

Question from Pace: Who do you feel should be responsible for what specific drugs do to people?

Dr. Jeff Kahn: I'm not a lawyer, but I am married to one, so here goes. The drug companies bear responsibility for the use of their products, though the distributors (including physicians) bear some responsibility as well.

Question from Pace: Do you feel that the government should be responsible for importing drugs in this manner, even though it's over the international Internet?

Dr. Jeff Kahn: It's a question of how our government can regulate the importing of drugs from overseas. The Internet has made it possible to buy and sell so many things that drugs are just one of many. My guess is that our government will get to this sooner rather than later.

Question from NY_Democrat: Can't the taking of drugs such as Viagra (which have gotten widespread publicity) by people who don't need them have dire medical consequences?

Dr. Jeff Kahn: Viagra is a special case, in a way, because of its potential for misuse. I'm told it won't help normal men perform at higher levels, so don't waste your money.

Chat Moderator: Do you think there will come a time when the FDA will need to regulate drug company ads more heavily? Is this time now?

Dr. Jeff Kahn: Absolutely. I think the FDA would like to do a more thorough job of regulating drug ads but don't have the person power (read money) to do it. It may be getting to the point that they'll need to change that.

Question from Candyce: Dr. Jeff, are you concerned about the glitzy ads that promise so much to consumers who see them?

Dr. Jeff Kahn: Yes. They're very effective, I think. And the risks and side effects are buried in tiny type that no one can read. The good news is that physicians still need to prescribe drugs. The bad news is that it takes more of their time to dispel the myths created by ads.

Question from Lucy: I heard that Abbott and Pfizer stocks have gone through the roof in recent years. Why is this? Is this due to successful advertising?

Dr. Jeff Kahn: Pfizer equals Viagra, and the estimate is that Viagra was a $1 billion seller in its first year; partly a function of advertising, but also the value of the product. It's also been the case that pharmaceutical stocks outperform most others -- it's a very good business.

Chat Moderator: We know you have to leave soon. Any final comments on prescription drugs and direct marketing?

Dr. Jeff Kahn: Thanks to you all. One last thing: Remember that information is key to controlling our own health, but we need to be sure it's information we can trust. See you all again soon.

Chat Moderator: Thank you, Dr. Jeffrey Kahn, for joining us today.

Dr. Jeff Kahn: Thanks for having me.