Introduction to Healthcare Delivery in the United States 3

Direct-to-consumer (DTC) advertising

1997: FDA allows DTC provided “adequate provision” of information requiring fairly balancing risks and benefits.

• Research regarding DTC show mixed effects:

• One study (Berndt, 2005), reported 40% of physicians believed it was positive, 30% negative, 30% no effect.

Direct-to-consumer (DTC) advertising Pros

Educate consumers about conditions and symptoms

• Increased adherence

• Enhanced communication between physicians and patients

Direct-to-consumer (DTC) advertising Cons

Increased promotional expenditures

• Increase price

• Increased demand

Counterfeiting Prevalence

~ 30% of global drug market in the developing world

Counterfeiting Consumer risk

Receive not benefit from drug when there is no active ingredient

• Experience adverse events, including death, from drugs with harmful and toxic chemicals

• Delays access to effective treatment

Additional Counterfeiting Concerns

Limited accountability for guilty parties

• Increasingly difficult to eradicate origin points

Causes alarms around certain medication products

• Likely to skew reporting data of adverse effects

Fosters greater distrust of healthcare system

• Public appearance of disorganized processes

Barriers to clinic & system level change to increase patient trust

• Fear of healthcare institutions

• Suboptimal community relations

• Impact of poverty

Fear of healthcare institutions reasons

• Difference in how provider view themselves vs how patients view them

• Tendency toward intimidating language among providers

• Minimal diversity among staff providers

• Relationship feels more transactional than relational

• Lack of sensitivity to unique patient care needs

Current climate between some community members and healthcare institutions

• Less opportunity for community members to serve as research investigators AND trial participants

• More beliefs of exploitation by healthcare institutions for professional gains

• Results in fractured collaboration that occurs on an inconsistent basis

Impact of persisting poverty

• Lower health literacy rates

• Diminished decision-making

• Poorer outcomes