What if drug ads...

Increase the placebo effect?  In other words, the ubiquitous ads for cholesterol decreasers and anti-depressants may be lowering the actual results for the drugs and/or raising the response to placebos.

But why would the placebo effect seem to be getting stronger worldwide? Part of the answer may be found in the drug industry's own success in marketing its products.
Potential trial volunteers in the US have been deluged with ads for prescription medications since 1997, when the FDA amended its policy on direct-to-consumer advertising. The secret of running an effective campaign, Saatchi & Saatchi's Jim Joseph told a trade journal last year, is associating a particular brand-name medication with other aspects of life that promote peace of mind: "Is it time with your children? Is it a good book curled up on the couch? Is it your favorite television show? Is it a little purple pill that helps you get rid of acid reflux?" By evoking such uplifting associations, researchers say, the ads set up the kind of expectations that induce a formidable placebo response.
The success of those ads in selling blockbuster drugs like antidepressants and statins also pushed trials offshore as therapeutic virgins—potential volunteers who were not already medicated with one or another drug—became harder to find. The contractors that manage trials for Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America," says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. "It's basically luxury care." [More]

This is more than just a curious psychological observation. Huge drug companies have been one of the points of pride in our current health care system.  Any other system, some argue reform would stifle the free-market drive that has given us all these wonder drugs that now improve our health.

But if the drugs are in effect expensive placebos (or even partially), what is the real value pharmaceuticals really create?  Is it outweighed by the enormous and growing cost?

Prescription drug prices in the United States are the highest in the world. "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue."^[1] However, national expenditures on pharmaceuticals accounted for only 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures).^[2] The high price of prescription drugs is one of the major areas of discussion in the U.S. health care reform debate.
Prices of brand name drugs in the United States are significantly higher than in Canada, India, the UKprice controls. Prices for generic drugs tend to be higher in Canada. The price differential for brand-name drugs between the U.S. and Canada has led Americans to purchase more than US$1 billion in drugs per year from Canadian pharmacies.^[3] and other countries, nearly all of which have
As an example of the extremely high U.S. drug prices, consider the cholesterol drug Lipitor, one of the best selling drugs in the world. At CVS, a leading U.S. pharmacy, Lipitor (40mg/90 tablets) costs $361.99. At Drugstore.com, another U.S. pharmacy, the same drug costs $335.97. While in Canada at CanadianOnlineRx.com pharmacy, the cost is $215.46, and in India at licensed pharmacy InternationalDrugMart.com, the identical generic drug costs $120.94 (Source: All costs in US$,19 May 2008, from the respective pharmacy websites).
To save money, "U.S. Customs estimates 10 million U.S. citizens bring in medications at land borders each year. An additional 2 million packages of pharmaceuticals arrive annually by international mail from Thailand, India, South Africa and other points," reports the Washington Post.^[4] A few years ago, uninsured Americans would often purchase their cheaper medications from Canadian pharmacies. However, today, consumers shop at lower-cost online pharmacies in India, the UK, and other countries where they can save even more money -- up to 60 to 80 percent or more savings off US prices.
Pharmaceutical companies argue that the prices they set are necessary in order to continue to fund research. Only 11% of drug candidates that enter clinical trials are successful and receive approval for sale.^[5] Critics of pharmaceutical companies point out that only a small portion of the drug companies' expenditures are used for research and development, with the majority of their money being spent in the areas of marketing and administration. [More]

If nothing else, the difficult health insurance reform debate will frame discussion of future medical cost inflation and coverage far differently.  Even if perceived as unsuccessful, the alternatives offered as improvements will remain in our minds as the system tilts further toward both eventual insolvency and growing inequality of care.