OPM—or is it?

Not long ago, I was having lunch at the cafeteria of the Brookings Institution, a venerable think tank here in Washington, DC.

As I paused in line to select a paper cup for water, the person behind me offered help. When I explained that I was merely deciding which cup size to take for the complimentary beverage, he made what can only be described as the quintessential Washington quip: “So, a decision without economic consequences.” Only in DC.

In one sense, the same argument about economic consequences might be made about prescription drugs. For those of us on corporate payrolls at least, the decision about which medication to use is made with little consideration of the monetary outlay. By and large, insurance from the company where we work covers prescription costs, minus some form of copayment. Although copayments are generally rising of late, most of us rarely think about the overall cost of the prescription—much less whether the drug is as effective as we hope, or if there are alternatives.

But here’s the interesting twist. At the same time that we’re not thinking about prescription costs, we’re beginning to ask more and more for specific medications. These requests are being made, of course, because of advertising, or more accurately, direct-to-consumer (DTC) advertising from pharmaceutical companies.

The first DTC ads appeared in 1981 in consumer magazines; they touted ibuprofen, then available only by prescription. Before then, pharmaceutical advertising appeared only in professional periodicals and journals. Drugs from other manufacturers soon followed suit. The first DTC television ads appeared in 1997, after the FDA approved the use of that medium on the condition that the ads be truthful and balanced. Thus, there were ads with a recitation of medical contraindications for various drugs. However, there was virtually no discussion of efficacy, placebos, or other valuable information. Now even contraindication information in television ads is gone, so long as there is an 800 phone number where such information is available.

Last year, the pharmaceutical industry spent nearly $2 billion on DTC ads, and a mere half dozen drugs accounted for most of those ads. The names Claritin, Zyrtec, Viagra, Celebrex, and Vioxx have become ingrained in our culture because of the incessant television spots and magazine ads. This may not be bad—by and large, information should make us better consumers, or at least more aware of the choices available to us. These days, we take responsibility for everything, from the selection of mutual funds for our retirement to the choice of schools for our children. Why shouldn’t we have some say in the selection of the drugs we use to treat our ills?

That would be fine if we had all the information needed to make informed decisions. Unfortunately, it doesn’t appear to be quite so straightforward. In a recent article titled “The Claritin Effect” in The New York Times Magazine, Stephen Hall described how this most popular of antihistamines is marketed as the best of all possible treatments for allergies. Yet for most people, Claritin is no more effective than over-the-counter antihistamines like Chlor-Trimeton, a drug costing one-tenth as much as its prescription sibling. In addition, the National Institute for Health Care Management Research and Educational Foundation reported that surveys show that consumers believe DTC prescription ads are approved by the government—a belief that, while not true, raises an ad’s credibility.

Most of us can make decisions that have both a medical and an economic quotient to them. But we need information such as medical and economic alternatives. For ultimately, what we’re spending on drugs isn’t “other people’s money”, it’s ours.