Every now and then one of our adamant free-market types will launch into a lengthy diatribe that reduces to, "What do we need government regulation for, anyway?" In my experience, the folks who take that position tend to be highly educated and informed debaters who are quite successful in their own lives and have compelling case-histories to cite as well as reams of GAO and DoC data at their fingertips. In short, they are very persuasive and can wear you down. And hell, I'm the first to admit that in theory, in the best of all possible worlds, I'd like to live in a society where government intrusiveness is minimal. As noted in my previous post.
Then one night I'm sitting there in the middle of dinner and I see an ad like that shown above for a drug called TriLipix (that's try-LIP-ix), one of the newer entries in the war against cholesterol. The key action comes 24 seconds into the spot:
TriLipix has not been shown to prevent heart attacks or stroke more than a statin alone.Digest that for a moment. Clearly the whole point of taking this drug is to lower cholesterol and triglycerides in order to reduce the risk of heart attacks and strokes. I quote from earlier in the ad: "Are you taking a statin medication to lower your bad cholesterol, but your good cholesterol and triglycerides are still out of line? Then you may not be seeing the whole picture." A few seconds later, the narrator begins a sentence with, "If you're at high risk of heart disease..." The ad, in other words, is appealing to people who want to reduce their risk of having a heart attack or a stroke. Which means that those 5 seconds in the middle of the spot, in essence (if not in fact), invalidate the other 55 seconds. The disclaimer quoted in red above, which is only there because of FDA regulations, is saying, "This drug is useless to you." (At best, if you want to split hairs, the disclaimer is telling you that the drug has not been shown to be useful.) Remember, too: The absence of a proven benefit does not = the absence of harmful side effects. As the long list of potential health hazards in the balance of the disclaimer shows.
But if the typical model holds, pharmaceutical giant Abbott Labs has spent over $1 billion developing and commercializing TriLipix. Abbott employs 68,000 people in 130 countries, and needs to be able to cut their salary checks while still delivering an adequate return to its investors. And apparently there is clinical evidence that, "along with [a low-fat?] diet," the drug does lower triglycerides (even if, again, all that has not been shown to offer any actual health benefit to people already taking the likes of Zocor or Lipitor). So Abbott is going to sell its glossy new drug. The company wants its share of the $18.4 billion market for cholesterol-lowering meds. Whether TriLipix "works" or not.
More to the point, I ask you to imagine what that ad would look and sound like without the FDA and/or FTC. I'll tell you what it would look like: a giddy symphony of uplifting imagery—a parade of 115-year-old grandparents gleefully running through parks, tossing frisbees with their adoring 75-year-old grandkids—that made TriLipix out to be the single most important breakthrough in the annals of medical science. (Since the last drug advertised on TV, that is.) The cagey, carefully lawyered wording in the present ad would be replaced by unflinching statements of "fact." There'd be no purposely vague talk about how consumers "may not be seeing the whole picture"; that would give way to bold promises of life everlasting. There would be no disclaimers. In fact, without FDA regulations, I'm betting that TriLipix ads would imply that you don't even need the statins, that TriLipix alone would keep you forever ageless and running marathons through the hilly streets of San Francisco.*
I know what our more libertarian, capitalist types will say: Let it all get sorted out in the marketplace. Really? After how many people waste how many billions foolishly depending on TriLipix to save them from heart attacks and strokes? After how many people die needlessly from, or at least suffer with, the serious side effects? Yeah, well, even so, it's up to the people to be their own advocates. Caveat emptor! Oh please. Twenty percent of all high-school graduates nowadays are functional illiterates. And you're going to ask them to decipher page after page of fine print written in medical jargon? (That's assuming that drug manufacturers even released the information.) For that matter, SHAMblog has a highly literate audience, and I bet half the people reading this very post probably looked up the term statin just to make sure they understood the issue here.
The free market, left to its own devices, will not usher in untold riches and fulfillment for all. Maybe it might, in an ideal world, if people everywhere were motivated by sincerity and a profound love of all mankind. Alas, that is not the case. We know it's not the case. We've quite recently received plenty of object lessons in just how much it's not the case. Too many of us are motivated by a sincere and profound love of a huge bank account or a vacation home in the Caymans, and we don't give a damn what happens to the people we exploit in order to get there.
Say what you will about the nanny state, the fact is, sometimes we just need to be protected from the worst aspects of human nature.
* Then why didn't the FDA simply refuse to allow the drug to be sold at all? That's a tough one, because, as noted, TriLipix does do something: it lowers triglycerides and seems to raise "good" cholesterol. And in general, I do think we want to err on the side of giving consumers choices. Still, they should be fair choices, where consumers are provided with sufficient info. And based on what we know about TriLipix, you have to ask yourself: What informed consumer would buy this drug?