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How pharmaceutical companies find sick users on Facebook (themarkup.org)
191 points by atg_abhishek on May 7, 2021 | hide | past | favorite | 166 comments



“If you’re a drug manufacturer looking for patients”.

Maybe I’m just too Scandinavian to understand, but wouldn’t it be the other way around?

Now I also wonder if I should see a doctor. I’ve been getting a lot of “is your will in order” commercials from law firms on Facebook recently. I sure hope big tech advertising doesn’t know something I don’t.


In the US, it's legal to advertise drugs directly to patients. There's not a lot of places in the world where it happens, I'm assuming Scandinavia is one of them.


One particularly funny side effect is that the narrator needs to read out a comprehensive disclaimer.

I was once on holiday and with US TV, and saw a few times an ad for performance enhancement for older gentlemen. The ad showed an older couple, who first are not very happy, then much happier with each other, frollicking in the long grass and disappearing off shot etc.

While that was happening, the narrator was reading in an impassioned, but also somewhat undulated voice: "side effects include headaches, blurred vision, hypertension, liver failure, paralysis and death" [I can't quite remember the list, basically it went from minor to death, as most drugs do].

For someone not at all used to serious drugs being advertised on prime-time TV, this was quite a thing to see.


It can be even funnier because they only need to read the side effects if they say what the drug is supposed to treat. Because of that, you get the drug ads that never list side effects, but you're left wondering what the drug actually does after seeing a bunch of people running through fields and hearing a bunch of vague things about a better life.


It’s bizarre even as an American who is used to it. The most amusing thing is they’re clearly running out of good ideas for names. The names are getting stranger every year. They’re basically just gibberish now.


It has to be a branding/patenting thing around uniqueness. I couldn't imagine trying to come up with new website names on a daily basis that would be expected to stick in a consumers mind.


There are whole consultancies around picking drug names.

The name isn't supposed to make an actual claim about effectiveness--you can't call it "cancercurazine"--but they often try for something vaguely suggestive: Viagra sounds like it makes you 'vital', Wellbutrin makes you feel well, Zyban keeps you away from nicotine, etc.

I've heard--but can't find a source saying--that this is why varenicline is sold under two different names: someone felt like 'champix' was too suggestive.


The big pharmas have a long list of gibberish names that has been created. These lists have already been vetted for uniqueness, trademark ability, etc. When a new product needs a name, they turn to these lists.


Like "Rebelius" - a diabetes treatment for all the rebels out there.


Otezla (O-Tesla pronounced) for arthritis. No ac current involved


It reminds me of the "Happy Fun Ball" ad parody on SNL years ago.

https://www.youtube.com/watch?v=GmqeZl8OI2M


My favorite part is when they tell you "Don't take Oprexmia* if you are allergic to Oprexmia".

* My first attempt at a made up drug name was Xaljenzia (my thought process was they seem to love the letters X, J and Z) but apparently there is a Xaljenz so I ended up with this.


I guess these would be considered as proper nouns thereby making them invalid Scrabble words?? Otherwise, hit a tripple word score, and essentially do a mic drop with these when played.


There are other fun examples of these extremes. WebMD will pretty much always suggest cancer as a cause of whatever subject you researched. Most of the pharma ads will include "death" as a possible side effect. however, a possible death side effect was much less of a death knell than when olestra had to include anal leakage as a possible side effect.


It was a culture shock to me as an American that moved back to the US. Turned on regular TV only to see shows constantly interrupted by commercials. After that I put the STB in the closet and use streaming services.


Those ads are inadvertently revealing -- they make it plain that it's a medical and pharmaceutical _industry_. Let the patient be warned not only of side effects but to the nature of that industry.


Maybe it’s because of how we buy prescription medicine. You’ll get the prescription from your doctor, and then go to a pharmacy where they will default to offering you the cheapest brand available at the time of your purchase, and ask if you’re cool with that.

So we sort of have a culture where you only really stick to certain brands if you’ve ever had a bad reaction to a copy product. I’ve got a hay fever for instance, and for the past many years I’ve stuck to the same brand of antihistamines because I once bought a box that made me nauseous and I just went back to what I had previous used. This is anecdotal of course, but it took me almost a decade to learn the name and not just ask for the ones in the green box.


I don't think it's only that - there are plenty of ads for medications with no generics. I think it's also because doctors may usually prefer one treatment for an issue, but if you mention another treatment you found (either via ads or your own research) they might be willing to prescribe that instead. Hence the common ad copy "ask your doctor if _____ is right for you."


Honestly, the differences between filling something in the states and Norway isn't that big - get a thing from the doctor, go to the pharmacy, and get the cheapest option (with a few exceptions). The pharmacies usually ask me if the generic is OK (some people care, after all).

The bigger difference I see here is that in the US, I generally got loose pills in a pill box, and here in Norway, I'm more likely to get a standardized amount of pills in blister packs or manufacturer packaging.

Quite simply, prescription drugs advertise in the US because they are both allowed to do it and the name-brand drugs get more people insisting on the name brand because they advertise, even though it costs the person more (sometimes, a lot more).


Very few drug commercials are for drugs with generics. They almost always hold a monopoly position.


I (in the US) get drug ads online for drugs I've never heard of, that give no clue whatsoever what it does or what condition it treats.


As far as I know direct to consumer drug advertising is allowed only in New Zealand and the US. In most countries it’s illegal.


Did you fill your date of birth on any age-protected content (websites for distilleries or breweries, for example) as 1st January 1940 or something? They could just mistakenly believe you're 81 based on that :)


I'm in my early 40s and just got shingles. Based on my googling the past few weeks I expect AARP and mechanical stair chair ads any time I'm not using adblock from here on out.


I guess you will also start getting more "shingles in your area" ads.


Only if Sean Connery is the ad manager.


But it could be similar to the case where Target was able to targets ads to women who did not even know they were pregnant.

In this case, the above commenter could be doing things signaling that he may need a will soon due to diseases or life situation that he is not aware of. Or he/she has looked into content similar to those people in need. ¯\_(ツ)_/¯


For every "Big Tech figured out my diagnosis before I did" there are a thousand instances of "You just bought a fridge--I bet you love buying fridges, here, let me show you some".


People do take products back they don’t like. So statistically it’s not as unlikely as you might think.


More realistically you should tag the users profile to show them fridges in about 3 years when it first starts to either experience minor mechanical issues or starts to look “dated”. Just tag with refrigerator_2025 or something.


The really nutty one I've seen--Amazon apparently only looks at correlation without regard for causation. Buy ink, it starts showing you printers that use that ink.


> But it could be similar to the case where Target was able to targets ads to women who did not even know they were pregnant

In this case, she knew she was pregnant. Her family didn't.


The target story is nice anecdote but it's unlikely that they figured out that the daughter is pregnant: https://medium.com/@colin.fraser/target-didnt-figure-out-a-t...


Yeah I can't believe people are still parroting this at all.


Well I’ve had a friendly hemorrhoid for a few years that I frequently see a lovely anal surgeon for and I probably have some “this might be cancer” search entries from a few years back, but it’s been so long that I should’ve died by now if it was actually cancer down there.

Other than that I have no idea heh.


If you gaze long enough into an abyss, the abyss will gaze back into you.

Depending on what you personally get up to, opsec is increasingly vital for normal people. I'm not talking about serious stuff - everyone has secrets.

Well, had.


Replace the word patient with customer or "money".


I work in a (California) medical facility. "Patient" is now a deprecated if not archaic term, no longer used. Patients are now properly referred to as "clients" for at least 5 years now.


While it's all semantics in the world of business speak and HR, this feels to me like it orients the relationship as any other business transaction.

I want to be a patient, in to see a doctor for diagnosis and/or treatment. I don't want to be a client, I'm not here to iron out a SEO contract.


See also "passenger" vs "customer" on transit systems.


I understand that we all have to keep up but how on earth is patient an "archaic term" when compared to client?

Both words are derived from Latin and have seen some service. Patiens - "sufferer" seems appropriate for someone who is suffering - they tend to gravitate towards Doctors. A client "cliens" is more of a legal term - it was used to denote someone who had a lawyer or was "protected" by a patron.

I think that patient is the more appropriate term for your customers (originates from Latin - "tax gatherer.") 8)


Patients and doctors need to know about a medicine to prescribe it. In order to increase brand awareness, drug companies can either advertise to or incentivize (free trips to conferences, consulting gigs) doctors to prescribe a drug or get patients to directly ask their doctor for a drug.


Do doctors prescribe brands in America? Here they’ll prescribe you with the working substance, and unless it’s still patented (which most of them aren’t) then you’ll just get offered the cheapest brand at the pharmacy by default.

I guess commercials would still work if you branded yourself hard enough, but our culture is more like the Velcro thing, where when people ask for a “panodil” or a “pinex” they don’t really care if it’s actually a panodil or a pinex as long as it’s a headache pill with that the same sort or working chemical.


They often prescribe brands in the sense that they will literally write the brand name in their own hand on the prescription, and that is technically literally exactly the prescription. However, the pharmacy can substitute a perfectly equivalent drug on its own recognizance based on the doctor's prescription, but the distinction seems to technically exist. (The pharmacist position takes a lot of study and licensing as well.) I believe a doctor can or could write "no substitutions", but things aren't quite bad enough that a doctor would risk their license to do that to bolster sales for a brand or block a patient from receiving generic medication--they'd need some kind of concrete reason, like knowing or suspecting a patient is allergic to an inactive ingredient. (It's all theory, because our doctors are overworked and would never pay that kind of attention.)


Pretty sure insurance companies have it down to a science to cover all cheap generics over brand name and through you through bureaucratic hell with pre authorization forms until you are beaten into submission to take the cheap version (more $$$ for insurance company)


Sometimes they do, but often they tell the pharmacy that they can use the generic (and most folks seem to want generic). Occasionally, they insist on the brand, but this is more often because while most generics are the same, sometimes there are differences. Lithium, used as a mood stabilizer, is the example I can think of, but is far from the only one.

More people want brand name for over the counter - like panodil/pinex - but sometimes this is because folks don't realize that the generic is the same drug.


For some specialised conditions in the UK - they actually do prescribe exactly the brand/version.

For my posttransplant meds some of the are explicitly "must" be this version. Also some meds (anti rejection) are dispensed direct from the hospital


Few new drugs get invented each year and most are either slight modifications to existing drugs or highly specialized. Doctors can easily keep up with zero advertising needed.

Drug companies advertise to convince doctors that drug X is better than it actually is. Which is obviously bad for patients who are better served by an objective approach to prescription drugs.


I’ve interacted with a lot of doctors in my job and no, most doctors aren’t that aware. You’ll get the doctors involved in research who know all about the drugs years before they are approved, but those are a handful. Like most people who have jobs you focus on the here-and-now and while “yeah I’d love to read up on that new drug, but I don’t have time”.

I worked on one drug where we had to go to and tell them to stop buying it (they were still buying lots and if they return it a year later it would mess up our accounting) because there were far superior drugs available. We’re talking malpractice not to use the new drug. They thanked us for letting them know.


The last part is shocking to say the least. It’s hard as a patient to imagine a doctor, seen as medical authority figures, have such a passive approach to the latest drug efficacy w.r.t. their prescribed treatments. That’s why teaching hospitals have more modern technology and pulse on the cutting edge.


I wouldn't like to be severed by a drug. I prefer my body to stay in one piece, thank you.

But I agree that doctors don't need advertisement. Just publish a technical magazine 2 to 4 times a year with a technical description of the drugs available and let the doctors make the call.


Oh I agree that it's a complete racket that hurts patients, I just wanted to provide some rationale from the drug company's perspective.


Doctors do, but I'm not sure patients will ever have enough knowledge to be able to make an informed choice.


Interesting article on a Uber for cremations company:

https://www.theguardian.com/global/2021/may/07/funeral-grace...


The article seems to suggest this is a bad thing, but my first reaction is "fantastic". Pharmaceutical companies create life saving medicines and then use advanced social media targeting to locate the people that need them.

The only bad thing about it is if those people targeted can't afford the medication, which is why healthcare needs to be a universal right.

People love to bitch about Big Pharma but I have a magical little blue tool that completely relieves my asthma, and I can buy them with absolutely no trouble at the pharmacy for about $6. My brother got diagnosed with MS recently. My aunt got diagnosed with MS 40 years ago. Thanks to the research that happened in the last 40 years, my brother's experience with MS is worlds apart (mostly because we live in Australia and he has free access to tens of thousands of dollars of treatment).

Pharmaceutical companies are responsible for developing vaccines for a global pandemic at light speed. They're great! Let's celebrate Big Pharma!

But let's also make sure that the gains from these amazing advances in technology are shared equitably.

And maybe, just maybe, if the medical companies find they need to use Facebook to shift their product, we should be looking at a more formal and closely regulated method of distribution that isn't so commercially driven.

I mean, the private sector is great at commercialisation, but is it really the be all and end all when it comes to such a crucial social function as healthcare?


Or, I go to a doctor, who is a medically trained professional, and they prescribe a medicine to me based on their experience and training, without any incentive for financial reward?


Do you think that doctors don't have financial incentives to treat patients?


My doctor is certainly not backed by investors who are putting her under pressure if she doesn't make 10% ROI.


They should have an incentive to treat them, they shouldn't have an incentive to suggest specific medication.


For what it's worth, it seems doctors are heavily advertised to: https://slatestarcodex.com/2019/05/22/the-apa-meeting-a-phot...


No, I don't pay the doctor, the healthcare pool does. And then, the doctor is incentivised to cure me, not keep me in a perpetual drug-purchasing lifestyle as big pharma would.


Doctors get cash and hospitality benefits from big pharma though based on how they prescribe. If there is drug X from company Y and drug A from company B and then there is no difference in therapeutic benefits between two drugs, but company B gives doctor cash and has access to regional sales data where the doctor operates, they can modify the benefit based on sales. Then the doctor is incentivised to prescibe the A. This may be harmless, but if the doctor gets into a financial trouble or simply get overwhelmed by greed, this can quickly turn into something that harm patients. In my country doctors don't have to disclose those relationships and they don't even have to declare this as income.


This is absolutely not true in most countries. Where I practice you can get into big trouble for this. You have do declare pharma affiliations, cannot accept sponsorship and the age of junkets through drug companies is long in the past.

I could be deregistered if I was found to be accepting anything (travel, hotels, conferences) and not declaring it


Great that your country stamped this out, but I am afraid you are the minority. Pharmaceutical industry is the most corrupt after politics and army and almost no doctor is immune to bad influence. Straight up denial is actually harmful in getting the truth out there and fixing the problem.


You aren’t saying anything substantial here. The world renowned scientists coming up with the discoveries that allow us to live long lives should not be bucketed with the MBA goons trying to mark up insulin shots and corner the market with medical patents they acquired.

What industry do you work in where those at the top of the companies aren’t maximizing their ROI and profit seeking? That COVID shot in your arm ID from the scientists that worked feverishly to invent it, and should be celebrated like the ones that solves medical mysteries across all different disease classes. R&D is not free period.

Why not have the government subsidize medical costs, why punish the inventor who have huge R&D overhead? The corruption you talk about starts and ends with the government.


Wondering which country you are? can add it to the bucket list of countries to retire in.


Australia. This is the rule in most developed world economies, although I have to admit complete ignorance of the US (... the largest developed world economy)

I was invited once, by another doctor, to speak (paid gig, curtin closer) at a conference being put on by a pharmaceutical company. It was on digital health and the company I think may have had an interest in anaesthetic drugs or supplies or possibly it was surgical - (I’ve just trawled my records and without spending an hour or more I don’t think I’m going to find it) either way there were lots of Anesthetists and surgeons there, mostly because for only $100 they could knock off 20 CPD points by coming and listening to something half interesting in a nice venue for a while and get a meal and catch up with each other.

I had to fill out pages of forms with the company to get paid, firmly renounce that I would be promoting any drug or product, resolve to declare my affiliation with them for a minimum of 12 months, etc etc (this was in around 2018).

The company’s logo was on the pull out banners and the projection screens obviously but there wasn’t even a hint of drug or product anywhere in the room. No tote bag, just some mints and the pad and pen.

The ethical bar has been raised so high that medical companies are now reduced to running paid conferences on adjacencies that clinicians may possibly be interested in, that align with their college’s professional development goals, and can’t even mention their products!

So why do they even do it anymore? I pondered this as I filled out my forms - I believe it is due to residual infrastructure and marketing apparatus and budgets from the days when they could offer the world. Now they’re like vestigial organs, floundering to maintain purpose but knowing that a KPI is eyeballs on logos

The kicker is, if it was anaesthetics, there are only probably 2 makers of sevofluorane in the world anyway!


In my country, general practitioners can only prescribe a limited number of drugs and specialist visits a month, so as not to overwhelm the healthcare system. It's their moral choice to deem a person sick enough for a certain course of action.

Whatever pill the doctor writes me up, I always end up asking the apothecary or looking up online the cheapest substitute. This is how the elderly here cope, they can barely pay bills, let alone choose which pills to skip. I've personally not had any problems with big pharma substitutes so far.


Not where I live. This is a uniquely US problem among first-world countries.


Technically I don't think it's unique to the US. In Denmark doctors get a fee per consultation. It's pay with tax money, but still the doctor is financially motivated to see patients. It might only apply to general practitioner though, I think hospital doctors are on a fixed salary.

One issue, that could excuse medical companies going directly to the patients would be a lack of knowledge among doctors. Doctors contently write prescriptions for medication that's no longer available and is often not as updated as a pharmacy on new medication. This means that at least some doctors aren't suggesting the best treatment, simply because they aren't aware of it.


The doctor can also put a generic name of the drug on the prescription and patient can tell the pharmacy to sell them a particular brand instead of a generic. So there is space where such direct advertising could work.


A financial incentive to treat? No, that's pretty common across healthcare systems. It's being worked on as system move away from fee-for-service, but generally, the more a physician does, the more they make.


Ireland is extremely for profit in everything they do and very poor compared to many places in Europe in terms of response and quality.

People just assume a lot about the world.


I don't think it's fair to put Ireland in the same category as the USA here:

1. Zero ads for prescription medication anywhere 2. Medical card for everyone on low income covering everything 3. Never pay more than EUR114/month for prescriptions, no matter how much you medication you need or your income.

I've never had doctors pushing any kind of medication on me or my family.


I was curious about another HN poster from Ireland so I looked at your other comments and you're defending RTÉ so it's safe to say we won't see eye to eye.

You're a glass half full type of person, to put it in polite terms.

I could rant all day about media and health in Ireland. Specially from a migrant perspective but it's not really the place.

What is undeniable is that Ireland ranks amongst the worst in Europe and it's very much for profit. It's just Irish people don't know any better and they look at the wrong place (USA) and only at the money aspect, not the quality.

Quality wise, I'd much rather be in USA than Ireland because treatment here is terrible in many cases and there's always a sea of excuses and bureocracy.


Poor people in the US also get free everything...


You need to go to a doctor anyway. Not all of them are good, and imo they shouldn't have absolute say in what you take. If you suggest some medication you saw an advertisement for, they should take it into consideration instead of telling you to stfu about it. Yes, my experience with doctors has been terrible.


without any incentive for financial reward?

Except when they do get financial rewards?

https://www.nytimes.com/2019/05/02/health/insys-trial-verdic...


You appear to be assuming the advertisement medically benefits a patient.

I don't believe there's any evidence for this and ads for prescription drugs are banned almost globally for good reason. "Ask your doctor about" may bias the doctor away from a different drug that is more appropriate but has a lower profit margin, for example.


There's some benefit to the patient if the drug is effective treatment for a condition they knew they had but didn't know there was treatment for. Or if it's a new thing that treats something where the old treatment didn't work well or had bothersome side effects for the patient.

Major new drugs may get news coverage or may be brought up if a doctor sees something on your chart at a checkup, but ads may (or may not) reach more people.


Have you heard the expression, "A solution in search of a problem"? Because that what this is. Multinational billion-dollar corporations using their marketing dollars to convince people that their pill is the solution to all of your problems.

This should be illegal.


It either is or it isn’t, at the end of the day a Doctor was taught what to prescribe at med school and you can’t demand they prescribe you anything unless you are a drug seeker and will be blacklisted quickly if it’s controlled substances.

Go look at peer reviewed studies and clinical trials data to make an informed decision on medical treatment options.


I don't know why you were downvoted into the grey zone. I don't entirely agree with your points about Big Pharma finding needy patients instead of doctors prescribing based on professional experience (though there's still plenty of room for bias there too) but overall, fully agreed, the pharmaceutical industry is a wonderful thing on the whole, and while it gets a lot of knee-jerk hatred from too many people, i'd love to see somebody suggest something practically better (as opposed to ideally better based on their limitless dreams of a perfect world).


Maybe the bribery to get your Doctor to recommend a different drug than is probably best for you or your pocket book?

Maybe the campaigns pushing opioids on doctors and patients to the point of crisis?

Insulin is at least twice the price (depending on type might be 3 or 4 times) in the $US as anywhere else in the world.

There's that famous case where a Turing Pharma skyrocketed price of Daraprim that only they were manufacturing because, well, they could get away with it.


  "Insulin is at least twice the price"
That is the government's fault. What's the reason you can't import extremely cheap insulin from overseas? The government has endowed a local monopoly.


I don't think you can entirely blame unethical, predatory behaviour on the government that enables it.


It's not a government that enables it, it's a government that enforces it through laws that guarantee and endow a local monopoly. Whenever you have an endowed monopoly without substitutes, you have extremely high prices. It's econ 101 and will happen 100% of the time (that's why I call it enforcement instead of enablement). If the government just got out of the way, the price of insulin would plummet.


What's stopping US companies from competing based on price? There's multiple producers of insulin in the US. Why do you need a foreign company to undercut them? If an international market would fix it, why doesn't the national market fix it? Why doesn't one of the US companies charge less than the others?


Because of price fixing among the 3 big insulin providers, which is only possible in an environment where competition is heavily constrained by monopoly powers (or in this case, oligopoly powers) endowed by governments through the patent system.

If we have an international free market that encourages 10+ competitors that aren't banned from producing insulin due to patents, then price fixing becomes impossible.

So if government just got out of the way (in this case - patents and banning imports), you could import cheap insulin from anywhere and the problem would be completely solved.


So you think it's an accident that pharma corps make lots more money under the regime enforced by government? Or, possibly the pharma corps have engineered this situation politically (ie 'buying' politicians in some way - campaign donations, advisory jobs, etc).

Why else would gov arrange things this way of not at the direct [but covert] behest of the pharma corps? Do you think they're doing it (having overinflated prices for age-old life-saving medicines) to help citizens?


It's as you say - crony capitalism and corporatism. The politicians/government are corrupted and bought by pharma corps to create a situation where competition and the free market is stifled, which leads to high prices as the inevitable consequence. It's a principal-agent problem in the context of having a large state/government with extensive powers to interfere in private business.

You see this playing out everywhere; e.g. agriculture subsidies in rich countries, which just serves as protectionism for domestic farmers at the expense of poor-country farmers. The fundamental causal factor here is the large and powerful state - private, autonomous actors will always try to corrupt and co-opt the state's powers for their own benefit (whether that's farmers, pharma corps, oil companies, hedge funds, tech firms, or whoever), so laying the causal blame at their feet is misguided since their attempts to do so are inevitable. It's a government problem.


Why on earth should the patient choose whichever drug put money into advertising, rather than the one their doctor deems the most suitable? How could that possibly be beneficial?

edit: reading further down the article, there is an advert for an antipsychotic medication which offers a $15 discount on your copay. This particular medication has serious discontinuation effects, it's not something you can just stop taking and it's not something that is prescribed lightly in the first place. Offering a discount for the first few doses is plainly exploitative.


There are some aspects to the supply and demand of drugs, particularly psych drugs, that I'm not sure are described in econ 101 or popularly known.

Let's say the most common, first prescribed drug for your condition is available in a generic, for $0.30/month. That's not entirely hypothetical, that really happens.

A naive person would say "ok, if the generic is so cheap, then the brand name can't be much more, can it?" - free market competition, the FDA ensures they're all equivalent, blah blah blah.

However, I noticed that in recent years, the alternatives to the dirt cheap first-line option are way more expensive and going up. So I thought about why.

It occurred to me, that a simplistic view of competition ignores the fact that the different options are not exactly in competition at all. Because everyone tries the cheap one first, and then if they have problems or it's ineffective, they try another.

This means that fundamentally the drugs which are supposed to be in competition are not in competition practically speaking. If you have a drug that is not the first option, then you might as well charge $1000/month because everyone who is a possible customer already by definition has given up on the cheap one.

And even worse, in order to justify (for example) $1000/month, you don't have to have something better, just different enough to give people a little hope. They proliferate, but it's not progress.


Let's go ahead and see what the FDA found out about direct to consumer (DTC) advertising of drugs as they've conducted numerous surveys[1].

Not all bad it seems!

- Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.

- Many physicians thought that DTC ads made their patients more involved in their health care.

- Physicians thought the ads did not convey information about risks and benefits equally well.

- Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

- The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.

- Doctors believe that patients understand that they need to consult a health care professional about appropriate treatment.

[1]https://www.fda.gov/drugs/information-consumers-and-patients...


If the blue tool you're talking about is an inhaler, I'm happy for yours being $6, as was mine I believe, but some still aren't so fortunate. They still go for $300-$500 for some people, in the U.S.

https://www.health.harvard.edu/blog/millions-skip-medication...

"Died because couldn't afford inhaler" will bring up some fairly good hits.

Things have been fairly good, and are always mostly getting better - but damned if we couldn't be so, so much better than we are given the other things our country fronts billions upon billions of dollars for is the idea always lingering in my and others minds.


Has everyone forgotten the OxyContin scandal? Or are we just all grateful that Big Pharma has saved us from the pandemic that we're going to overlook the past specific, illegal, actions of pharmaceutical marketing?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

> When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000.1 The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.


So one company running wild without government intervention selling a controlled highly addictive narcotic negates all medical discoveries by big pharma since the dawn of time including the record breaking speed of making a COVID vaccine? Yeah okay…


In almost all these cases the doctor should know what the patient needs, pushing patients to ask their doctors about certain medicines.

The one case I think drug ads are legitimate is when it's a dramatic improvement in treatment for a live-with-it type condition. The prime example would be Viagra--before Viagra there were not any good options, a patient very well might not mention it to their doctor so the doctor wouldn't know to suggest it. Thus "talk to your doctor about new options for erectile dysfunction" ads should have been acceptable to run for a while. I'm not sure what the medical situation was when the overactive bladder ads were coming out, that one might also be acceptable. I can't think of anything else right now.


Yeah so I guess the users have nothing to say in this. If I walk in to store they supposed to know what I want and a clerk puts the items into my basket and kicks me towards the checkout.

Are you serious?


The vaccine has me thinking of these things, and my reaction was closer to yours. I don’t think ads here are fantastic. What I think is fantastic is companies wanting to remove the “dis” from “disease”. But we must not rely on pharmaceuticals. They are just a few tools in the tool belt of healing.


I can relate to this from my personal experience of having a sick family member. Five years ago, my father-in-law was diagnosed with Multiple Myeloma, a rare blood cancer. I was close to him and joined several support and information pages on Facebook. Since doing that, I see ads on Facebook and elsewhere targeted to me as if I too had cancer. Now my father in law has passed, yet I still see ads that remind me of the horrible disease he battled.


Have you tried telling Facebook to not show you these ads through the 3 dot menu in the top right? I don't go on Facebook much anymore, just curious


Ironically, you are helping Facebook when you do this. Their algorithms get tuned by users saying they don't want certain ads.

This is why I stopped doing this on Instagram.


Of course they do. But if you don't want to see a certain type of ad, especially one that brings up painful memories needlessly, why would you care?


> Their algorithms get tuned by users saying they don't want certain ads.

Do they increase or decrease the targeting of ads towards the types of people who say that they don't want to see these ads?


I did this for ALL ads on FB over many months and am now relatively as free. It helps that I only visit FB from a browser that’s isolated from other web browsing.


No, but that's a great idea to try.


Can you not turn off certain ad types in facebook?


"How Big Auto finds users with car troubles on Facebook"

"How Big Lighting finds users with blown bulbs on Facebook"

"How Big Chocolate finds users with cravings on Facebook"


The difference is that Facebook says they specifically avoid sensitive health information https://www.facebook.com/business/help/361948878201809?id=18...


And nowhere in the article it's said that they use sensitive health information.


A distinction without a difference.

I suspect that this is how Facebook justify some of these things. They don't explicitly provide data, anything that advertisers choose to intuit from data is up to them. But I think this is a fundamental misunderstanding (or unwillingness to understand) privacy.

Privacy needs to be treated like a security concern. It basically is one. In security any place where more information is disclosed than intended is considered to be a security flaw in some sense. If there's a correlation between likes and health concerns that allows for statistical inferences about users health, that's a security flaw.

The thing about security like this is that it takes active work to solve these sorts of problems. Facebook are only doing the "passive" work of not giving advertisers the exact data. A counter example is Apple's "differential privacy" which does a lot more work to only preserve very specific tracking information and statistical properties.


> They don't explicitly provide data

Because first and foremost, FB doesn't have explicit health data.

> If there's a correlation between likes and health concerns that allows for statistical inferences about users health, that's a security flaw.

Then any information is a security flaw.

Just being male/female or age alone allows for significant inferences about users' health. Not many 18 year old women are gonna click on those prostate exam ads. Similarly, those interested in body building probably won't be interested in "fat burning" pills, and those following transgender-themed pages are gonna be more interested in HRT ads.


How anyone finds users that will buy their products on Facebook: serve ads, report revenue, and let FB figure out how the fuck to optimize it without you doing a goddamn thing.

Frankly that's all that digital marketing should be (a button PMs press, not a division at every company), I'd rather one or two highly regulated and excruciatingly scrutinized companies manage all the details than millions of small shitty ones that nobody pays attention to. I fully agree with everyone including Kara Swisher that FB is not as regulated as it should be, but that model does seem ideal to me if we can figure out the regulation.


Regulation is pretty simple, ban collecting information on users behaviour for advertising.

If advertising is forced back into being based on the content you are currently viewing or the site you are currently on or the key words you typed into the search bar ... this levels the playing field for all advertisers and ends the adtech arms race.


And location data tracking


> that's all that digital marketing should be (a button PMs press, not a division at every company

Who writes/designs the ads that are served? Who decides how much revenue is spent? Who interprets the reported revenue? Who decides whether the ads are working? Who sets the strategy for the next round of ads?


Alcohol companies too are allowed and actively targeting people, kills your liver, no one bats an eye.. what gives?


You beat me to it. Digital marketing 101.


Is there some proof that big pharma really targets sick people? The article mentions targeting for things like "cancer awareness" as a proxy for cancer patients.

But why target patients? Patients usually don't decide on the drugs they take, doctors do, they should be the target, not patients.

So maybe we can take things at face value, big pharma is not targeting cancer patients, instead they are targeting those who are the most likely to have an interest in cancer besides patients: health professionals.

Note: I don't live in the US, and generally, only doctors get ads about prescription drugs, I heard the situation is different in the US for some reason.


When I visited the US a few years ago it seems like every TV ad break there was a "Feeling X, ask your doctor about Y". Where X was some generic condition like bloating or feeling old, and X was a brand name prescription drug.


I can categorically say that is untrue. While not a fan of direct pharmaceutical marketing, the FDA has strict rules about what needs to be in an advertisement. Chiefly, it must address:

* At least one approved use for the drug (the actual medical condition that it has been tested for)

* The generic name

* Nearly every side effect the drug can give you. There are some side-rules on that one.


How can you categorically say that is untrue while not providing any evidence to the contrary, but in fact confirm the other person's observations?

Essentially: they said commercials have A and B, you said that's untrue because comercials have to have A, B, and C.


The OP said 'generic symptoms.' There are no prescription drugs for 'generic symptoms', they must have a specific approved use and they must be mentioned verbally in the commercial. Here is the evidence to the contrary:

https://www.fda.gov/drugs/prescription-drug-advertising/pres...


Yeah but let's be real, while the "specific approved use" might be clear to a medical practitioner in a journal write-up related to FDA approval, the actual prescription ads shown to normal people attempt to use as general simple wording as possible to describe symptoms. To laypeople these start to blur together to very simple statements like "feeling tired? Worried about excessive weight gain?" While these might be symptoms of a specific FDA approved use of the drug, it results in an atmosphere of confusion for normal folks.


I’m sure the paragraph of tiny text at the bottom of the screen technically met the above requirements. Doesn’t change the substance of the advert.


Is there a practical difference between intentionally targeting cancer patients and intentionally targeting proxy signals for cancer patients?

This is the whole part of internet marketing targeting right? You don't know for certain if someone is a cancer patient without their medical records, so you record a load of signals and infer that someone is likely to require cancer medication in the absence of absolute information.


The patient can say to the doctor "I feel that X drug may be better for me than Y". Sure, ultimately it's the doctor decision, but if patient puts enough pressure and the doctor thinks that there is no material difference between X and Y except e.g. price, they may side with the patient for the sake of their peace of mind. You know the placebo factor etc.


This is true, but not as frequent in my rural town in my experience.

Most have terrible insurance plans or no insurance at all and I have to use whatever is cheapest on Walmart/Publix/Winn-Dixie standard formulary.

Other towns or specialists may have different experiences.

Source: me, small town MD.


The ads are effective to bring awareness. There are doctors who will “help” patients to discover if they have conditions to warrant the use of the drugs they saw on TV or social media ads.

This brings patients to doctors, then they get lab work done and finally the use of drugs. That activates the full value chain of the system meaning that all the participants in that chain get paid.


So, in the end, it is not a bad thing if it gets patients to be treated early.

Sure, the goal is to sell stuff and make money, but if it makes people healthier, we shouldn't complain. It is only a bad thing if it results in a less effective treatment.


Facebook is disclosing to third parties that its users have an "interest" in a medical condition although FB purports not to disclose users' medical conditions.

Per @refurb in the comments, when people have an "interest" in a medical condition, they almost always actually suffer from that condition.

It's almost like the algorithms are in charge over there, unsupervised.


I don't think it's an algorithm, I think it's a bunch of executives who think they are really smart because they found a loophole in the law.


> How Big Pharma Finds Sick Users on Facebook

Living in a country where advertisements of pharmaceuticals are allowed, it's unbearable. Basically Facebook in real life - in TV, on billboards, in newspappers, YouTube ads, omnipresent leaflets. All flavours of dietary suplements, Rutin and Ibuprofen products, cures for fungal and intimate infections, wonder cures for liver and joints, "digestion catalysers". They're throwing the most awkward and malignant stuff at everyone. Pharma industry is malicious scum and has to be kept on short tight leash.


I had to come back to my home country for a few weeks now, having been away for one year and a half, and it's absolutely insane how every ad on tv and radio is for drugs. They even target children for car sickness. Instead of educating people to avoid these things, everything is: smoke and bad breath, get breathazol, drink too much or eat only unhealthy stuff: forteliver plus. There was a movement to ban all pharma advertising, but the lobbying was just too strong and the project did not move forward.


Ah yes, the radio ads - forgot to mention these.


So vintage!


How is that different than any other ads? I'm more sick of car, credit/loans and insurance ads than pharma. I ignore all of them, anyway.


One example is actors looking like doctors advising painkillers as an anwser to back pain or headaches. Together with unavailable public and expensive private healthcare that's quite toxic mixture.


Painkillers are generally effective against back pain or headaches. Much fewer side effects than amputation.


>Pharma industry is malicious scum and has to be kept on short tight leash.

That sounds a bit anti-vax.


The industry has repeatedly put profits ahead of people's well-being, Oxycotin being the easiest example. Their actions should be met with severe skepticism.


Revlimid, Humira, Trikafta, I can go on and on. There are many, many great drugs that save people's lives. Obviously Purdue committed crimes with how they marketed the drug but remember Oxycontin was FDA approved and it had a massive black box warning that said THIS DRUG IS ADDICTIVE.


>Oxycontin was FDA approved and it had a massive black box warning that said THIS DRUG IS ADDICTIVE.

They lied in their submission to get it FDA approved. And that massive black box only appeared 20 years after the introduction of the drug.

As I said, they place profit over the wellbeing of people. That doesn't mean they don't save lives, but if it's more profitable to save fewer they'll generally prefer that route.


You are talking about one company peddling one class of highly abusable drugs here, not the whole industry researching and developing life saving drugs that aren’t addictive and abusable to anywhere near the same degree on a neurochemical level. So yes this one company did a bad thing, why tarnish the reputation of cholesterol or plaque reducing, etc. med companies just trying to pay the scientists to create the discoveries and profit to fuel even more molecule research and discoveries?


>You are talking about one company peddling one class of highly abusable drugs here,

Yes, I provided just one example. Here's another one, trying to ensure patent rights on the covid vaccine. Or the common practice of releasing a slightly different version of a medication when the patent expires.

>just trying to pay the scientists to create the discoveries and profit to fuel even more molecule research and discoveries?

Then why do they have a marketing department and a lobbying budget? They have repeatedly shown they require heavy regulation.


Industry or select few executives lining their pockets and government officials they are in bed with to look the other way?


As usual, the scientific side is (mostly) fine, it's the marketing side that's a disaster.


I like targeted ads. I just wish they were better. For example I am open about being in recovery for alcoholism on FB but they still show me ads for hard liquor.


I'm afraid you might not be seeing beyond the first-order effects: "ads are annoying, relevant ads are less annoying, therefore I like surveillance!" Consider all the implications that ubiquitous surveillance by unaccountable private entities carries.

Plus, the fact that you can advertise extremely harmful drugs such as alcohol (or gambling) at all, not to mention do so precisely to those you figure are more susceptible to this manipulation is pretty disgusting in itself.


Calling it surveillance is like Steve Ballmer saying about Google "we don't read your email." No human at Google is reading my email. They are scanning it and associating keywords to my account. Do this make me a marked man? Some might feel that way, but this technique is not very accurate and is only used to show me ads when they are going to show me ads anyway. Ads are part of the current reality whether we like them or not. Why not prefer relevant ads?


>Consider all the implications that ubiquitous surveillance by unaccountable private entities carries

I've legitimately never seen an implication other than "I'm uncomfortable with it" that isn't illegal.

>Plus, the fact that you can advertise extremely harmful drugs such as alcohol (or gambling) at all

Yeah, advertising those things at all should be illegal.



I guess a simpler fix here would be to explicitly opt out of certain classes of ads eg gambling / alcohol. It feels like we should have rights not to see ads for damaging products.


“Targeted” ads have -never- shown me anything I actually wanted to buy.

On the other hand, whenever I really wanted to spend spare money, say on new games or movies or music, every fucking company tries to put as many hindrances in my way as possible: The search systems of almost all stores is terrible and their filtering options are crippled.

With the exception of Steam, every store I’ve tried makes it really hard to find items matching some specific criteria.

Way to go ya Silicon Valley nincompoops. /clappingemoji

How about instead of pillaging my privacy to try to inaccurately infer what I like, why the fuck not just let me TELL you what I like?


> I am open about being in recovery for alcoholism on FB but they still show me ads for hard liquor.

Or perhaps you see the ads because you are open about your recovery. If the relapse rate is high, you will be blanketed with such ads.

FB's targeting AI is pretty good. Even people recovering from alcoholism were being targeted, the advertisers might not even know it.


I hadn't considered that. That would be evil, so I need to pay more attention to when this happens and try to understand it better.


I believe if you look in your ads settings, you can disable ads about alcohol products explicitly.

Take a look and good luck man.


No, that's definitely a targeted ad at you. You relapsing would be profitable.


Anyone who wants to can scroll through my comment history and see that on average I’m the ex-FB guy defending FB. And usually the claim or accusation is debatable, if not dubious.

But as someone who’s got a lot of sweat equity in seeing FB ads pay for all that long-haul fiber that HN smart asses take for granted, FB is on legitimately thin ice here. It’s possible for someone with a blog to learn things about a cookie that shouldn’t be shared. What FB can know and what FB should know, and what FB will admit to knowing are potentially all different things.

FB should learn to forget medical data, sexual data, political data, etc. etc.

The short term erection some lit major at an agency gets from seeing some intrusive targeting option is not worth the trust that FB has somehow managed to maintain with most real users. And if you’ve got a new take on why FB sucks and turned down an offer, feel free to take it there. The world has more than enough “I’m angry at leetcode” deep threads.


My wife used to be an example of targeting going really wrong on YouTube. She used to only watch stuff in Mandarin (her mother tongue)--their targeting had absolutely nothing to go on and thus was nuts. I would say the majority of the ads she got were pharma ads, but for a whole slew of things. Everything I noticed was niche stuff, I would presume groups narrow enough that they did some ads aimed on age alone.


You only have to look at the ads Signal ran to expose this, to see the sort of information facebook will give advertisers.


I didn't know The Markup. The articles and the methodologies used are very clever.


what seems to be a problem here? is not this the whole idea of the relevant ads?


Ughhhhh


Ughhhhhh




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