Rarely these days does a relaxing hour of watching TV, reading a magazine or listening to the radio go by without encountering an advertisement for a prescription drug. Indeed, there has been a remarkable increase in such direct-to-consumer (DTC) prescription drug marketing budgets over the years, skyrocketing from $1.3 billion in 1997 to over $6 billion in 2016 — a 361 percent increase.
This is cause for concern and should be taken seriously. With mounting evidence that DTC prescription drug ads may do more harm than good, it is time for the U.S. government to take the drastic step of banning such ads. After all, the U.S. remains one of only two countries in the world — the other is New Zealand — to allow this practice.
DTC advertisements for pharmaceuticals were made legal in 1985, but only became widespread with the easing of guidelines in 1997. Today, DTC pharmaceutical ads are regulated by two sets of guidelines, each of which has drastically different thresholds for approval. This can make it difficult to ban an ad that meets one set of requirements but doesn’t meet the other. The Food and Drug Administration (FDA), for example, requires all DTC advertising to be accurate and not misleading, to reflect balance between harms and benefits and to make claims only supported by substantial evidence. However, The Pharmaceutical Research and Manufacturers of America (PhRMA), a trade group representing pharmaceutical companies’ interests, requires ads to educate patients about treatment options, to increase awareness about diseases, to motivate patients to consult their doctors and to increase the likelihood that patients will receive appropriate care. The contrast between these two sets of guidelines is stark. While the FDA guidelines use clear wording, the PhRMA wording is much more ambiguous and open for interpretation, creating a lower bar for advertisement approval.
DTC advertisements have only been around for a little over two decades, yet they have already had a drastic impact on the advertising landscape and sharply contrast forms of legal pharmaceutical advertising permitted in other countries. In the U.K., for example, pharmaceutical companies are only permitted to advertise over-the-counter medicines DTC; prescription-only medicines can only be promoted directly to healthcare professionals who are authorized to prescribe or supply the product.
Pharmaceutical companies, like other companies that have products to sell, use DTC advertisements to increase the volume of drugs sold. In 2008, a U.S. House Commerce Committee discovered that for every $1,000 spent on DTC prescription drug advertisements, 24 new patients became customers of the pharmaceutical industry. Even more alarming is a 2003 research report that found that prescription rates for prescription drugs with advertisements were nearly seven times greater than for prescription drugs that were not advertised.
While physician surveys conducted by the FDA have found that many physicians think that DTC advertisements make their patients more involved in their health care and that such ads increase patients’ awareness of possible treatments, DTC prescription drug ads are likely to cause more harm than good for patients, their physicians, and the healthcare field as a whole.
Revamping the aforementioned guidelines is not the answer, however. Ensuring the accuracy of pharmaceutical advertisements — if this is even possible — does not change the fact that the average consumer lacks the medical knowledge necessary to interpret the messages of these ads as well as decide whether a certain drug is right for them.
The FDA surveys mentioned earlier, for instance, found that 65 percent of physicians believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. Additionally, around 75 percent of physicians surveyed believe that DTC pharmaceutical ads mislead patients into thinking that a drug works better than it actually does.
Drugs for diseases as serious as lung cancer or diabetes cannot possibly be explained in the scope required for legitimate understanding in a 60 or 90 second TV commercial. An advertisement released in 2019 by Bristol-Myers Squibb, a pharmaceutical company, for the advanced lung cancer drug Opdivo, for example, is full of vivid imagery of expansive skies and smiling faces, suggesting an open road to a healthy future. The average five-year survival rate for the type of lung cancer Opdivo is designed to treat is a meager 24 percent, and yet the ad proclaims Opdivo gives patients “A chance to live longer.”
The fact that Opdivo has the potential for major side effects including suicidal ideation is only briefly mentioned at the end in a rapid-fire list of this and other possible side effects. It is highly unlikely that consumers are capable of understanding the realities of taking Opdivo, as well as the countless other drugs seen in DTC advertisements.
Most viewers also fail to notice the tiny font at the bottom of their screens that states, “For adults with advanced squamous non-small cell lung cancer previously treated with platinum-based chemotherapy” and “Half of Opdivo patients were alive at 9.2 months versus 6 months for chemotherapy. Results may vary.” This is definitely a chance to live longer, but I would presume that most patients who see this ad do not understand the stark reality of the statement.
The oversimplified message, dramatic imagery and bubbly patients seen in the Opdivo advertisement are by no means unique. Most DTC pharmaceutical ads follow the same outline. After all, pharmaceutical companies know this approach sells drugs. What incentive do they have to change what works? I can’t think of any.
Americans trust the pharmaceutical industry and they trust DTC pharmaceutical advertisements to inform them about potential life-saving drugs. This is not unreasonable. Presumably, the pharmaceutical industry wishes to save lives with their drugs. If this were the case, though, pharmaceutical companies would discontinue their use of DTC advertisements and allow licensed healthcare professionals to assess the efficacy of a drug and its suitability for their patients.
For me, the simple fact that the U.S. is one of only two countries in the world to allow such advertising is worrying enough. Unfortunately, it is unlikely that pharmaceutical companies will voluntarily end DTC advertising on their own. We see again and again that profits tend to trump safety. It’s time we actually appreciate the reality of this observation. It is up to the federal government to step in and ban DTC prescription drug advertisements. This will not only promote patient safety but will reinforce the role of physician and uphold the ethicality that is crucial to any healthcare system.
Wesley Shirola is a Weinberg junior. He can be contacted at [email protected] If you would like to respond publicly to this column, send a Letter to the Editor to [email protected] The views expressed in this piece do not necessarily reflect the views of all staff members of The Daily Northwestern.