Evidence Based Everything Else

While watching yet another Direct to Consumer (DTC) drug commercial on TV, my son said something that provoked a forehead-thumping moment of "aha!" His was a general (hopefully rhetorical) question about why drugs should be advertised at all. Shouldn't doctors be the ones to tell people what medicines they need? (To which the answer is, "Duh.")

But I got to thinking, and interpreting the question as "Why is there such a thing as DTC advertising?" generated the obvious, if dismaying answer, "Because it works."

How do we know it works? Because if it didn't, you know damn well Big Pharma wouldn't be pouring billions of dollars into it annually. And that's when it hit me: every other business in the world works on the basis of evidence; especially advertising. If a commercial doesn't have the desired effect of increasing sales, it's pulled. If a certain mode of advertising is shown to pump up the bottom line -- whatever legal, moral or ethical issues there may be -- it runs. Any downsides (such as fines) are just "the costs of doing business."

So why should medicine be any different? Why is EBM such a hard sell? Maybe what we need is to commission a couple of New York advertising firms to do our EBM research for us. Hell, it's worked like a charm for Big Pharma.