How Americans Pay the Price for Drug Advertising

Drugs

The U.S. is only one of two countries in the world that allows direct-to-consumer drug advertising, and we may be paying a heavy price for it.

It’s difficult to watch television without hearing “ask your doctor” blaring from the latest pharmaceutical commercial.

Yet, these commercials that are so commonplace in the U.S.—80 air every hour, according to Nielsen—are a unique phenomenon. In fact, the only other country where direct-to-consumer drug advertising is legal is New Zealand.

In 2016, direct-to-consumer drug advertising was the sixth largest advertising category in the U.S., and it continues to grow.

Now, leading groups like the American Medical Association are calling for a ban on consumer drug advertising, voicing what many Americans are already thinking. In a poll conducted by STAT and Harvard School of Public Health last year, 57% of respondents said they supported a ban on drug commercials.

These commercials do more than just take up advertising air space. Big Pharma’s billion-dollar advertising budget can cause a host of problems, including high drug costs and adverse drug events.

The Evolution of Big Pharma Advertising

The following events were pivotal in shaping Big Pharma into the advertising giant that it is today.

1969: FDA Allows Direct-to-Consumer Advertising

The FDA permits consumer advertising to encourage price competition. Advertisements must include a brief summary of every known health risk of the medication. This requirement makes print the only feasible option for advertising since the health risks can be spread across multiple pages.

1983: FDA Pulls First Pharmaceutical Drug Commercial 

Boots Pharmaceuticals runs the first commercial for their ibuprofen, rufen. The company only advertises the price of the medication, believing that if it doesn’t make any medical claims, it doesn’t have to share the risks. But within 48 hours, the FDA orders them to pull the commercial.

1996: Claritin Finds a Loophole

A Claritin commercial exploits a regulations loophole by not specifying what the medication is for, instead telling viewers to ask their doctors for details. By doing so, they don’t have to list the drug’s risks.

1997: FDA Trims Advertising Regulations

Pressured by lobbyists and politicians, the FDA loosens advertising regulations by only requiring companies to share a medication’s major health risks in advertisements. Companies can now direct consumers to another source (a phone number, website, etc.) for more information.

Drug Advertising Encourages Pricey Prescriptions

Nine out of ten pharmaceutical companies spend more money on advertising than they do on research and development.

From 2012 to 2016, spending on pharmaceutical drug advertisements increased by 62%—more than any other ad category over that time. In 2016, drug companies spent more than $6 billion on advertising

This huge sum ultimately costs patients and impedes medical advances. Nine out of ten pharmaceutical companies spend more money on advertising than they do on research and development.

Though companies have to disclose the major risks in their ads, they don’t have to share data on the effectiveness of the medication or whether or not it is superior to a generic version. Drug companies heavily advertise their premium medications, often leading Americans to ask their doctors for expensive medications over generic versions.

“Looking at all the evidence about direct-to-consumer advertising, any reasonable person would support a ban on this dangerous form of marketing.”

According to the FDA, generic medications cost 80 to 85% less than premium versions, and they meet the same safety and effectiveness standards set by the FDA.

The American Medical Association (AMA) noted this discrepancy when they asked for a complete ban on direct-to-consumer drug advertising in 2015. The AMA said that direct-to-consumer advertising “inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”

We asked Dr. Ray Moynihan, Senior Research Fellow at Bond University and author of Selling Sickness, for his thoughts on banning drug advertisements altogether.

“Looking at all the evidence about direct-to-consumer advertising, any reasonable person—acting independently of the pharmaceutical industry influence—would support a ban on this dangerous form of marketing. [This] would inevitably bring improvements in health and health system sustainability,” Dr. Moynihan said.

Drug Advertisements Understate Side Effects

In an FDA study, participants were less likely to remember the drug risks listed in a commercial if they were played alongside distracting visuals or music.

Drug companies are required to list the side effects of their medications in commercials, but whether or not viewers can remember that information is another story. There are no restrictions against using visuals, music, and other design elements to understate harmful risks.

In 2016, the FDA conducted a study on viewer distraction during drug commercials. The agency discovered that viewers were less likely to remember the drug risks if they were played alongside distracting visuals or music. Instead, what viewers often remember are the images of happy and healthy people and the drug’s benefits.

In 2008, the FDA accused popular birth control YAZ of downplaying the risks of the contraceptive in their commercials. YAZ patients, the FDA reported, had a 74% increased risk of blood clots compared with patients on other oral contraceptives. The company was also accused of overstating the contraceptive’s benefits by claiming it could help other conditions like acne. 

The FDA sent YAZ manufacturer Bayer a warning letter in 2008 that said:

The[se] complex presentations distract from and make it difficult for viewers to process and comprehend the important risks being conveyed… The overall effect … is to undermine the communication of important risk information, minimizing these risks and misleadingly suggesting that YAZ is safer than has been demonstrated by substantial evidence or substantial clinical experience.

As part of a $20 million settlement with the FDA, Bayer aired a follow-up commercial that clarified the contraceptive was not approved for moderate acne or premenstrual syndrome.


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