There are Reasons to be Suspicious about drug ads on TV
Like many people I often stream TV on my own time. Some Sundays ago I realized that “Madame Secretary” was going to be airing real time in a few minutes so I decided to tolerate commercials I couldn’t fast forward through and experience network TV live. (Secret confession: I want to be Tea Leoni in my next life!)
While there are certainly commercials in streaming television, I must confess I wasn’t prepared for what I saw. During literally every break there was some kind of pharmaceutical advertisement (clearly the demographic for this show isn’t young healthy people), a drug for diabetes, a drug for irritable bowel syndrome, a drug for high blood pressure. Smiling people promised that the product being advertised was the best thing since sliced bread for their condition and might even help you lose weight.
The advertisements were followed by a review of side effects, a medical disclaimer (don’t take this if, tell your doctor if….) and then a comment that if you found the medication hard to afford, there was help available in the form of a discount coupon.
I worked in Big Pharma for 10 years of my career, although it was a long time ago. My leaving the industry wasn’t solely based on principal, but the timing did coincide with the debut of “Direct to Consumer” (DTC) Pharmaceutical Advertising approval by the FDA, which I personally found somewhat unsettling. Somehow Mickey Mantle hawking the benefits of Voltaren® on his golf swing (an anti-inflammatory medication for arthritis that is now available generically), or Dorothy Hamill figure skating up a storm on Vioxx® (another anti-inflammatory drug that has since been taken off the market) was a big shift from trusting a doctor’s decisions for treatment to patients more actively engaging in their care by asking for specific treatments.
Watching the drug advertisements interrupting Tea Leoni’s resolution of world crises led me to look more closely at how healthcare products and services are marketed to us. On the one hand, what could possibly be wrong with consumers having more information about available drug options?
Prescription Drug Advertising
Studies are clear that Direct to Consumer pharmaceutical advertising (DTC) has both positive and negative effects. Interestingly though, the United States is one of only three countries in the world (New Zealand and Brazil are the others) that allows pharmaceutical companies to market directly to consumers.
Now, years after the FDA approval in 1985, DTC pharmaceutical advertising is the most common kind of health information that the public receives. In fact, the average American TV viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician.
But the bottom line is the primary purpose of this advertising is to sell products. When measured 10 years ago, pharmaceutical companies were spending over $4 billion dollars on this kind of promotion. Good or bad, when patients ask for a drug by name their doctor is more likely to prescribe it.
Brand name drugs have patent protection, which means that the manufacturer can sell it exclusively for a period of time without any generic competition. It also means that these drugs will likely be considerably more expensive than other alternatives, which explains the offer for coupons to help lower the cost (more on that in a moment).
To heighten your awareness of what you’re watching and reading there are three kinds of pharmaceutical advertising to consumers:
* “Help Seeking ads” don’t mention a product by name but provide information about a condition encouraging patients to ask their doctor for more information. These ads are a “call to action” for patients, to bring up symptoms they might not otherwise consider important and usually coincide with marketing efforts to physicians by the company sponsoring the ad. Unless you specifically decline it, if your doctor uses an electronic medical record, you might even see these kinds of ads on a registration portal after you’ve disclosed why you’re there. While these ads can highlight treatments for symptoms patients might not be aware of, they can also be a source of “disease mongering.” Disease mongering is a term coined by the late journalist Lynn Payer to describe exaggerating the severity of a condition and the ability of drugs to “cure” them (Examples: hair loss, toenail fungus, shyness, low T).
*“Reminder ads” mention product names, and may include the dose or price but don’t make any claims about the product. The first of these kinds of ads appeared when Boots Pharmaceuticals promoted their generic ibuprofen, Rufen, as a lower price alternative to Motrin. Less common now, these ads might appear in print advertising that target a specific market (arthritis medications named in an AARP publication, for example).
* The third and most common type now are “Product Claim ads,” which mentions the product by name, states clearly what it’s used for, and includes information about how well it works and side effects/safety. These are the kinds of ads that interrupted my interlude with Madame Secretary, and are also found in various other media, including newspapers and magazines.
Some of the positive aspects of DTC pharmaceutical advertising that have been cited are:
- Strengthening the clinical relationship in shared decision making.
- Encouraging medication compliance.
- Reducing the stigma of certain diseases.
Some negative aspects noted are:
- Over emphasizing drug benefits.
- Promoting new drugs before the safety profiles are known (this is what happened with the aforementioned Vioxx, which was found to have a higher incidence of cardiac side effects than other medications in its class after it was in wide use).
- Increasing cost to the patients and the healthcare system over all.
Who Pays for Those Drug Discount Coupons?
Let’s talk about those coupons. Even though a coupon might lower the initial cost out of your pocket to pay for a medication, keep in mind there is no free ride in our healthcare system. Some part of the system is paying for that medication even if you aren’t (at least initially). Frequently the coupons aren’t options for people covered under Medicare and Medicaid. Pharmaceutical companies know that if a patient starts on a medication and is doing well over time, when that coupon program expires (usually when the product is well entrenched in the market) patients are reluctant to change medication and will likely ante up out of their own pockets.
How can you evaluate the drug advertisements you’re exposed to and engage in an informed discussion with your physician?
- If you see an advertisement for a drug that you think might be helpful for you, consider these questions for your doctor:
- What experience have you had with your patients on this medication?
- What are the other options, generic and brand name for my condition?
- What are the risks of this medication as opposed to other medications you prescribe for my condition?
- How much will this medication cost if I ever have to pay for it without insurance coverage or a coupon?
- If you visit a pharmaceutical company’s brand name drug website, you may want to consult this article from Health News Review to make sure you are well-informed about how you’re being marketed to.
- If your doctor prescribes a brand name medication for you that you’re not familiar with, consider scheduling a consultation with your pharmacist, a greatly underused resource for better understanding our medications and medication options.
- One way that pharmaceutical companies promote their products is to have physicians who are early adopters speak to other physicians about their experience. While there is nothing inherently wrong about this, an analysis by ProPublica last year showed that these early adopters and the doctors who come to hear them are, in fact, influenced by the payments they receive. The Physician Payment Sunshine Act requires all pharmaceutical and device companies to disclose what they pay physicians. You can see how much a physician has been paid by a pharmaceutical or device company here.
- If you are prescribed a brand name medication and learn it’s not covered by your insurance, and you and your physician feel it is the best choice for you, sometimes these medications can be covered if you can demonstrate you’ve tried other, less expensive medications first. This is referred to as “step therapy.” Many doctors are accustomed to navigating this process. A private patient advocate can facilitate this as well.
As patients have become more empowered to partner with our physicians in our care, understanding our treatment options, including medications, and how they’re promoted to us is paramount to effectively and cost efficiently navigating our health and well-being.