RFK Jr. wants to ban direct-to-consumer advertising of prescription medicine in the US. Most countries, including South Africa, do ban it. Should they?
In addition to institutionalising vaccine scepticism by promoting false beliefs about vaccine safety, Robert F. Kennedy Jr., as the Secretary-in-waiting of Health and Human Services under next year’s Trump 2.0 administration in the US, has set his sights on pharmaceutical advertising in the US.
As any visitor to the US will have noticed, its media is filled with advertising for prescription medicines.
They’re often quite amusing, promising an end to all suffering and a new life filled with sunny meadows, puppy dogs and loving families, before rattling off a legally required list of terrifying side-effects which often include a painful death.
Good idea
When RFK Jr. called for banning prescription-drug advertising, my first reaction – living in a country where only over-the-counter medicines may be advertised to consumers – was that this seemed like a good idea.
After all, it takes a great deal of training to competently treat disease and to understand how medicines work. Medicines are dangerous. They have side-effects. They have contra-indications. They have cross-reactions with other drugs.
It is already worrisome how many people visit doctors merely to declare what the internet told them is the matter, and to demand medication recommended by someone on social media. If I were a doctor, I’d already be going Dr. House on these “I did my own research” types.
Only in the US and New Zealand is it legal to advertise prescription medicines direct to consumers, which suggests that almost everyone thinks banning it is a good idea.
Of course, pharmaceutical companies in the US do not think it’s a good idea to stop the lucrative business of advertising to consumers, but since I am not a shill for Big Pharma (contrary to routine insults from both left- and right-wing critics), I don’t particularly care what they think.
Bad idea
Then I read an opinion piece by John C. Goodman, a senior fellow at the Independent Institute, who has a doctorate in economics and promotes market-based solutions to public policy problems.
He makes an excellent case that banning direct-to-consumer prescription medicine advertising is a bad idea, even if those medicines cannot be bought without a prescription in any case. Even requiring the silly high-speed side-effects and contra-indications warning goes too far for Goodman.
He argues convincingly that people are not taking too many prescription drugs, but are taking too few.
“Studies show that we get our best return in medicine on drugs,” he writes. “Per dollar spent, the return on investing in drug therapy is much higher than what we are getting from investing in doctor care or hospital therapies. For example, Columbia University’s Frank Lichtenberg has estimated that three quarters of the increase in life expectancy that we’ve enjoyed in recent decades is the sole result of our adoption of modern drugs.”
Many people who can be helped by medication suffer needlessly because they simply don’t know that these medicines exist, which is why they haven’t bothered to see a doctor about their complaints.
“The social value of drug advertising is that it alerts patients to the fact that there is a possible remedy for a chronic illness,” writes Goodman. “The payoff is that the viewer might seek medical advice from a doctor and get a prescription, where appropriate.”
He argues that the list of side-effects in an advertisement has no value, not only because nobody pays attention to them, but also because side-effects, contra-indications and drug interactions are topics best addressed with a doctor.
Convincing
This argument seems convincing to me, especially if you consider it from the liberal perspective that the government shouldn’t be in the business of suppressing information or banning free speech.
It is ironic, then, that an incoming administration that claims to support free speech and free markets (though these claims are utter nonsense) is intent on prohibiting pharmaceutical advertising to consumers.
Prohibiting such advertising withholds information that might prompt people to ask a doctor about medication for chronic or acute illnesses. Not only does this cause unnecessary suffering (and even death), but it also steers people away from conventional medicine and into the arms of quacks who peddle alternative (read: unproven) medicine, and who are not hobbled by an advertising ban.
Goodman’s argument is that there is no harm in advertising medicines to consumers, since they must consult a doctor anyway, and it is up to the doctor to decide whether a particular drug is appropriate for that patient.
Hard drugs
This raises another question, however.
Like many libertarians, I have argued that possession and use of recreational drugs should not be illegal. The war on drugs has failed, and has caused more harm than good, because the drugs fight back. This war has destroyed the lives of a large number of victimless offenders and incentivises brutal criminal syndicates that perpetuate the war against the state, with civilians as collateral damage. Prohibition is a counter-productive policy, which is why even hard drugs ought to be at least decriminalised, and perhaps fully legalised. Substance use should be a matter of personal choice. Addiction and substance abuse should be a medical problem and not a police matter.
Why, then, should medicines be subject to prescription regulation at all? If one ought to be able to purchase recreational drugs such as cannabis, cocaine, heroin or methamphetamine for personal use, then why should methotrexate, benzodiazepine, opiates and opioids, statins, prednisone, omeprazole, dexedrine, insulin, antidepressants or antibiotics be kept behind a paywall, controlled by a cartel of licensed professionals?
Conflict
This is one of the few issues on which I have never been able to form a well-considered opinion that can stand up to reasonable challenges. My view on recreational drugs conflicts with my view on scheduled medicines.
While I’m certain that nobody ought to be criminally prosecuted for the possession or use of any drug, provided they do not infringe the rights of others in doing so, I’m far from convinced the sale of drugs, either medicinal and recreational, should not be restricted and regulated.
On one hand, people ought to know that drugs can be both addictive and dangerous, and should have the sense to consult experts (i.e. doctors) before taking them. If they choose not to, well, they have a right to be stupid.
Government exists to protect people from others, not from themselves. A government that begins to protect people from themselves will be on a slippery slope to totalitarianism. Next they’ll be prescribing diets, and exercise regimes, and bedtimes.
On the other hand, it is clear to me that an entirely free market in medicines would likely cause a lot of accidental misery and death, even if these harms are self-inflicted, and that the existing system of medicine control seems sensible.
Liberty versus safety
Yet this is not as good an argument as it sounds. We also choose to live in a largely free society, despite the fact that police states are often better at suppressing crime and assuring individual safety (provided you don’t raise the ire of the regime, of course).
Liberty brings with it personal risks that we consider worth taking. Why shouldn’t it be so with medicines?
In this case, I don’t have an answer. I remain open to arguments both for and against scheduling medicines.
Thanks to RFK Jr.’s proposal to ban direct-to-consumer prescription drug advertising, however, which prompted me to read up on the idea, I have now been convinced that it should be perfectly legal, and South Africa’s prohibition on pharmaceutical advertising should end.
[Image: Vintage poster advertisement for medicine, from publicdomainpictures.net.]
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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