Where Does DTC Go From Here?
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Updated presentation from Defined Care 2004 summit on the role of rx drugs in society with implications for marketing, managed care and disease management.
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Where Does DTC Go From Here?
- 1. “ Don’t Worry, Be Happy —” Where Does DTC Go From Here? Laurie Gelb, MPH
- 2. The views expressed in this presentation do not represent the views of any other person, company or industry organization.
- 3. This deck is an update of a presentation to Defined Care 2004, sponsored by Managed Care On Line. The author is now Principal, Profit by Change
- 5. “ Feeling good” or “feeling better—” when do needs differ from wants? Luxury Survival need Means to end Self-contained Massage therapy? Allergy meds? Rx/OTC/ACM is unique Higher education Employment Entertainment Leisure travel Home electronics Fashion clothing Upscale housing Housing Food Warm clothing Acute rx/tx
- 7. Our goal: the “right” synergy We want the right patient to take the right drug at the right time, the right way, for the right reason, and thereby address a medical need
- 8. We’re lonely at the top, because the stakes are high Resentment Ignorance Poverty Denial Fear
- 11. Fear & loathing in the headlines, risking suboptimal decisions
- 20. When does realism fatalism? Mike Twohy, New Yorker, 6/10/2002
- 31. Fatalism’s easy when dinner’s now the villain… Michael Ramirez
- 46. [email_address] Wherever we take DTC, the patients have to be there Laurie Gelb, MPH
Editor's Notes
- We are Puritans still “ Doc in a box” – demeaning term, never caught on because we want to feel individual care given – but now showing up in Krogers with NPs – diminished scope “ Fix in a bottle” won’t catch on, either…we take it, but we don’t feel good about it, and there’s a lot of impetus against it, e.g. DARE
- Lots of barriers to taking drugs, taking drugs right We put on pedestal but also pitch as right here, right now – instant access Does it look like we are touting the access or the drug?
- You can’t feel about your drugs the way you feel re the industry – you wouldn’t take them Any more than you can feel about your doc how you feel about your insurance company, or the system in general Still basic tension between wanting to believe health care/ rx is healthy, good, extends lives and… If you use these resources, you are not addressing the real problem—you’re avoiding it, back to the Puritans – sense of need for self-denial – am I worth these resources?
- Some auto insurance is cutesy – some is somber.
- Reimportation – we have the right to pay less and it’s absolute But scare tactics around counterfeiting, potency,
- No drug is 100% effective and safe for all So why do we market as if audience is homogeneous?
- Health vs. disease position Blurring line for when to seek care and when to seek drugs (OTC, supplement)
- A single word can be important – what does it mean? Do more 1 x 1’s because of social bias in groups
- There is always responsibility in taking a drug – you are putting something into your body that can have severe consequences – but what are the benefits? What are the risks? The fast voiceover at the end sounds like we’re buying a car
- We know how much involvement with picking a pipe, house or car is optimal – the parts to “leave to the experts” are clear Not so with health care – many voices say trust doctors, others say “only trust yourself” So how active should we be? The stakes are high, so erring on one side or the other, against one’s own impulses, is common.
- I want to believe that rx is tailored to me; DTC says the opposite.
- We need to feel that we have control more than we need it.
- Does CDH support either of these messages in regards to rx? Does CDH support the “health as money” doctrine in regards to rx? When it does, it’s a mistake. When we think that, we lose all faith in the “art” and believe in the cookbook. And safeguarding health is less precious to us as indviduals.
- Public Citizen doesn’t want emotional appeals to put people’s health at risk Neither do we But this is disconnected
- Realism trumps empty promises – we don’t keep buying cars that don’t run well Think of increasing sophistication of consumer – we’ve come a long way, baby – no more bacon breakfasts with a cigarette, marathon running for fun, etc.
- We need to answer the spoken and unspoken questions, not wait to be asked
- Some very nice patient education, and the best links you, the rx, and the outcome – all bound together That’s we need more of – not “you take drug and become something else” -- disassociation
- Confusion breeds both fear and anger Anger breeds both fear and contempt Opting out…becoming a junkie…similar motivations
- So if Humana thinks my disease is mine, not the drug’s to change, and I don’t… We both blame the drug co. for not providing better evidence
- Now I don’t know if I did the right thing, and whether it would be worse to d/c the drug I am susceptible to the environment, because I have not yet internalized its beneifts
- Fear of health care system can lead us back to the safe harbor: drugs Drugs don’t say, “how is your diet? Have you been walking? Are your parents living?” They don’t question But they require faith and hope to take
- The idea that supplements are more natural is dangerous Treat all substances with respect, including food It’s your body, not ours
- Again, rx is just part of your world – not a substitute for it
- Most DTC doesn’t mention OTC and supplements – bashes other rx, maybe But what is least likely to help the pt who really needs rx?
- Encourage realism You are not going to feel good every day, all day Nor will rx or any substance change that When we let supplements take the lead, people feel worse than they did, because the benchmark is so far out there…shiny, happy people everywhere But we don’t want to feel like we are really missing the boat or worse off than others. Run with that!
- Rx not trial and error – think about it and ask your HCP to do the same GIGO
- The pt wants to help herself Help her Encourage her Pt education is getting there, but then DTC deflects
- Article in Star Ledger – we are hiding discount programs
- All disease is not created equal, just like anything else Do you look at your leaky faucet or your leaky car first? Help formulate decision rules – distinguish between allergy sx that are and are not bothersome