How Americans got stuck with endless drug ads

How Americans got stuck with endless drug ads

In most of the world, this is a strange sight. It’s a TV commercial for a prescription drug. These ads are illegal in most countries. but in the US, they’re everywhere. On average, 80 of them air every hour on American television. “Ask your doctor.” “…my doctor told me…” “Ask your doctor.” The American Medical Association, a major group of doctors, has called for a ban on these direct-to-consumer ads. But there’s a case to be made for them too. So today we’ll take a look at both sides. First, a little background. Before the 1980s, prescription drug commercials were unheard of in the US. Drug companies focused their marketing solely on doctors, and they didn’t want to hurt those relationships. When asked by Congress in 1984, if direct-to-consumer advertising should be allowed, one pharmaceutical executive said: And an executive at Schering-Plough, which is now part of Merck, said: Needless to say, they changed their minds. At the time there was a larger cultural shift
in health care toward empowering patients to make decisions rather than just listening
to their doctors. And advertisements fit with that trend. Drug Ads started appearing in print publications, but there was still another thing keeping them off TV, and that was FDA’s regulations at the
time. They were interpreted as requiring ads to
include all of the information about the drug’s risks and side effects, which simply wasn’t feasible to do in a tv or radio commercial the way it was in
a magazine. There was a bizarre loophole though: The ads didn’t have to mention the drug’s risks, if they also didn’t mention the disease
or condition that the drug was supposed to treat. Here’s what that looked like — in an ad
for Claritin back before it was available over the counter: “It’s time.” “It’s time!” “Don’t wait another minute with Claritin.” “Claritin.” “I’ll ask my doctor!” “It’s time to see your doctor.” “Mr. Wilkin, the doctor will see you now.” “At last, a clear day is here.” Confused? Yeah, everyone was. So in 1997, the FDA clarified that the industry could run the full drug ads and wouldn’t have to give ALL the risk information from
the label, as long as they included the major side effects and referred viewers to another source for the rest. That’s why the commercials direct us to
phone numbers or print ads. Come for the pharmaceutical fine print — stay for “the secret to crisp contact in soggy conditions” That new FDA guidance removed the main barrier keeping drugs off of television. and you can guess what happened next… spending on ads quadrupled by 2004. And now, we know the names of prescription drugs like we know the names of cars and clothing brands. “Lunesta, Xanax, Celebrex, Flomax, and HGH.” “And as of Thursday, Lipitor.” “Oh and if you have trouble sleeping, Marla has Ambien. I prefer Lunesta.” “Lipitor, Baby Aspirin… Flomax.” “Flomax?” “…and some Cialis! I’m just assuming.” So that’s how we got here. Drug ads are now the most frequent form of health communication that most Americans see. So what does that mean for public health? Are those prescriptions going to the right
people? Or are they going to people who probably won’t benefit from the drug — people for whom the potential risks outweigh the potential benefits? Well, the answer seems to be: both. A clever experiment in 2005 tested this by
sending actors to real primary care doctors. Dr. Richard Kravitz: We helped them make appointments. In half of the visits, the actors reported
symptoms of depression. In the other half of the visits, the actors
said they were feeling down after becoming unemployed. The study authors called this an “adjustment disorder.” In some visits, the actors mentioned seeing
an advertisement for Paxil on TV, that’s an antidepressant. In others, they didn’t bring up medication
at all. And the doctors seemed to take patients more seriously if they mentioned seeing the Paxil commercial. They were more likely to refer patients to
a mental health consultation, And much more likely to prescribe an antidepressant. That may be a good thing for those with major depression, who might benefit from an medication. But it’s more questionable for those with
a more temporary condition. This study, and others, have shown that doctors can be persuaded to broaden the scope of who gets treated with drugs. And advertisements often seem designed to encourage that. Take Androgel — it was approved to treat men with hypogonadism: that’s extremely low testosterone levels due to injury or disease. But here’s how it was promoted by Abbott:
“Millions of men 45 and older just don’t feel like they used to. Are you one of them? Remember when you had more energy for 18 holes with your buddies? More passion for the one you love.” Some middle aged men don’t feel like they
used to? You don’t say. A study looking back at 10 years of testosterone prescriptions found that only half had been diagnosed with hypogonadism in the previous year. Drug ads give the industry an incentive to
make healthy people feel unhealthy. “Latisse is the only FDA approved prescription treatment for inadequate, or not enough lashes.” And they contribute to unrealistic expectations about what pharmaceuticals can do. So what’s wrong with that? Well, every single drug comes with risks. Big ad campaigns are usually for newer drugs, for which not all the risks may be known yet. In the case of the painkiller Vioxx, a massive ad campaign led millions of people with arthritis to switch to Vioxx instead of sticking with
older drugs like Ibuprofen. “It’s a beautiful morning…ask your doctor
today about Vioxx, and find out what Vioxx can do for you.” Vioxx was more expensive and not actually more effective, and… “The manufacturer of Vioxx have just recently pulled this popular arthritis drug from the market over health concerns.” Merck withdrew the drug after it became clear that it increased the risk of heart attacks
and stroke. A Kaiser Permanente study later confirmed
that ad exposure was linked to inappropriate prescribing of Vioxx and a similar drug called Celebrex. So that’s a worst case scenario. But there is also an argument that these ads can be good for public health. Sidney Taurel: “There are many diseases for which people don’t seek treatment. So if you can educate through direct-to-consumer
about the fact that this can be treated, you will get a better outcome for everyone.” In their view, more communication with your doctor is always a good thing. And it’s up to the doctor to make the right
prescribing decisions. Surveys of the public have confirmed that
drug ads prompt people to visit their doctor, in some cases for diabetes, hypertension, depression — these are conditions that are thought to be under treated. In the case of the HPV vaccine, that’s now recommended for all pre-teens to prevent cervical and other cancers, Merck’s ad blitz for Gardasil
probably reached more people than a government communications effort could. And whatever you think of erectile dysfunction drugs, they got men to see their doctors and undergo the required heart screening, potentially catching problems not yet treated. But the strongest argument in favor of drug
ads may be the legal one. The Supreme Court ruled in favor of prescription drug advertising back in the 1970s, when the state of Virginia tried to prohibit pharmacists from advertising their prices. Harry Blackmun: “We further hold that so called commercial speech is not wholly outside the protection of the 1st and 14th amendments. The individual consumer and society in general may have strong interests in the free flow of commercial information.” It was the first time that the Court said
advertisements were entitled to free speech protections. There was only one dissenting Justice at the time: William Rehnquist — who Ronald Reagan would later appoint Chief Justice —
In his dissent, Rehnquist wrote a kind of uncanny prediction of the type of commercials that would come decades later: “Don’t spend another sleepless night. Ask your doctor to prescribe Seconal without delay.” Rehnquist worried that ads would “generate patient pressure on physicians to prescribe” drugs; and that they’d end up being “advertised on television.” And as we know now, for better or for worse, that’s exactly what happened.


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