Everyone loves to hate television ads for prescription drugs. But now, several members of Congress are seeking some restrictions on the commercials. For example, Representative Henry Waxman, the California Democrat, wants to allow the Food and Drug Administration to bar consumer advertisements for newly approved drugs until they have proved safe in real-world use. Another Democrat, James P. Moran of Virginia is sponsoring a House bill that would ban ads for prescription sexual aids like Viagra and Levitra from prime-time television, on decency grounds.

Defenders of the direct-to-consumer drug advertising say this is a way to educate consumers and let them know of medical advances. But some critics say the ads do great harm, and reflect a pharmaceutical industry that has run amok.

How much harm to prescription drug ads do to consumers? Are these ads a valuable way to educate people?

These Ads Are Absurd

Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor in chief of The New England Journal of Medicine. She is the author of

“The Truth About the Drug Companies: How They Deceive Us and What to Do About It.”

Do we ask the Ford dealer whether his cars are any good?

Direct-to-consumer prescription drug advertising does exactly what it is intended to do — increase sales for drug companies. Increasingly, it does that by promoting medical conditions, as well as drugs. If the industry can convince essentially normal people that minor complaints require long-term drug treatment, its market will grow.

The argument that ads educate consumers is self-evidently absurd. No one should look to an investor-owned company for objective, unbiased information about products it sells. Do we ask the Ford dealer whether his cars are any good?

Back Off Congress

Ronald Bailey, Reason magazine’s science correspondent, is the author of “Liberation Biology: The Scientific and Moral Case for the Biotech Revolution.”

A noisy cadre of medical paternalists evidently believes that consumers will mindlessly gobble down any old pink or blue pill that greedy pharmaceutical companies want to sell them. Thus opponents of direct-to-consumer advertising of pharmaceuticals — including some members of Congress — want to protect gullible consumers by banning or limiting such ads.

Opponents of direct-to-consumer drug ads chiefly dislike them because they work.

The plain fact is that opponents of these ads chiefly dislike them because they work. Drug ads clearly do inform and educate patients. Research shows that direct-to-consumer advertising empowers patients by helping them identify their conditions and enables them to take more responsibility for their health care. In addition, drug advertising makes some consumers aware of the fact that their ailments may have effective treatments and encourages them to seek them out.

Read more… For example, in 2003, researchers at Massachusetts General Hospital, Harvard University and Harris Interactive reported in the journal Health Affairs the results of a survey of 3,000 adults of the effects of direct-to-consumer drug advertising. The researchers found that these ads appear “to affect patients’ behavior, resulting in more physician visits that detect treatable disease.” In fact, the survey established that of the 35 percent of the respondents who discussed these advertisements with their physicians, 25 percent received a new diagnosis. Nearly half of the new diagnoses involved high priority conditions like arthritis, high cholesterol or diabetes. In addition, more than half of the respondents reported that their doctors took actions other than prescribing the advertised drug. “Despite concerns about DTCA’s negative consequences,” conclude the researchers, “we found no differences in health effects between patients who took advertised drugs and those who took other prescription drugs.” Bottom line: back off Congress — drug advertising benefits consumers.

Ban All Pharmaceutical Advertising

James P. Othmer is a former advertising creative director and author of the forthcoming “Adland: Searching for the Meaning of Life on a Branded Planet.”

My all-time favorite pharmaceutical ad is for something called R.L.S. (Restless Leg Syndrome) a condition whose degree of absurdity is topped only by a drug’s potential side effects: “Tell your doctor if you experience increased gambling, sexual or other urges.”

Makes one wonder how many evenings that began watching the evening news with a bit of cappuccino-induced leg bouncing — something as innocent as, say, keeping time to the Mirapex jingle — ended in a Vegas hotel room with a bankrupt R.L.S. sufferer snorting coke with a transsexual hooker. “Well, I lost every cent of my 401(k) nest egg, and my marriage, and I caught a rare S.T.D. But at least I no longer have that irritating leg bouncing up and down thingy.”

Make ads that simply say, if you don’t feel well, go tell — don’t ask — your doctor.

If I had a dime for every time I heard the words “ask your doctor” or saw a crude clip of phallic imagery during a commercial break from the evening news, or was forced to contemplate a stomach-turning side effect, I’d be able to afford my own health care.

Read more… In fact, relying upon network news pharmaceutical ads as a cultural touchstone, a recent visitor to our planet would think that when we are young our legs can’t stop moving, that we menstruate four times a year, and we are ravaged by S.T.D.’s (despite taking great measures not to get pregnant), and we are extremely depressed; when we’re middle-aged we desperately want to get pregnant but can’t, perhaps because most men can’t achieve an erection (despite the fact that many others are afflicted with four-hour “reactions”), and we are also bald, overweight and extremely depressed; and when we’re old we are arthritic, forgetful, still depressed, riddled with cancer and either can’t urinate at all or pee so much we have to wear diapers. The United States and, for some reason, New Zealand, are the only developed countries where direct-to-consumer pharmaceutical advertising is legal. According to a recent York University report, in 2004 pharmaceutical companies spent twice as much on advertising and promotion ($59.5 billion) in the U.S. as they did on research and development. I’m convinced that if you invented a syndrome — Occasionally Twitchy Toe Syndrome (O.T.T.S.) — and put $2.5 billion in air time behind it, a market would arise overnight. So, instead of making ads that play off our fears, anxieties and neuroses, for products that need 30 seconds of legal copy for side effects that include death and blindness, not to mention a questionable F.D.A. situation, for syndromes you’ve never heard of, but sound kind of, you know, familiar, how about this: make ads that simply say, if you don’t feel well, go tell — don’t ask — your doctor. And while they’re at it, it would be nice if the same lawmakers who recently proposed scrutinizing big pharmaceutical ads took a similar long hard look at the standards and practices of another dubious marketing genre: the political ad.

Encouraging Better Conversations

Julie M. Donohue is an assistant professor in the Graduate School of Public Health at the University of Pittsburgh.



It seems absurd to think of those funny drug ads we see on TV with their long list of side effects as educational. The collective wisdom about commercials in general is that they are intended to boost sales through emotional appeals rather than information provision.

In fact, there is a long-standing and unresolved debate among economists about whether advertising informs consumers or manipulates them. Studies of drug ads show that they tend to overemphasize the benefits of a drug and downplay the risks suggesting limited educational potential.

For the sake of the patient, it’s better to regulate drug ads than to eliminate them.

Yet to evaluate the educational value of drug ads we need to consider the information currently available to consumers on prescription drugs. Research shows that consumers trust doctors above all others to provide information on prescription drugs. Unfortunately research also tells us that doctors and patients spend very little time discussing the relative benefits and risks of drugs (drug A vs. drug B; drug vs. lifestyle changes).

Read more… Studies show that physicians often fail to tell patients about side effects they are likely to experience from a particular drug, perhaps because they worry patients won’t take the drug if they do tell them. And patients seldom tell their doctors when they stop taking medications as prescribed. Prescription drug ads clearly increase demand for prescription drugs. They may also increase the quality of discussions between doctors and patients about pharmacologic treatments, but only if they adhere to Food and Drug Administration’s standards about fair balance between risks and benefits and stick to what clinical trials say about a drug’s safety and efficacy. Unfortunately the F.D.A. has not always been effective at policing drug ads because of a lack of resources. Proper enforcement of the existing rules governing drug ads may do more to create an informed patient population than severely limiting ads.

The Medicalization of America

Jerry Avorn, an internist and professor of medicine at Harvard, is the author of “Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs.”

Congress allocates the Food and Drug Administration about $2.4 billion per year to regulate our foods, drugs and cosmetics, a grossly inadequate budget. Yet twice that amount is spent by the pharmaceutical industry on direct-to-consumer advertising of its wares. Something is very wrong here.

It would make more sense for a neutral body to offer information about health issues and disease prevention.

Just as every other industrialized nation has figured out how to provide health care to all their citizens and how to get drug makers to negotiate the prices of their products, each of those countries (with the exception of New Zealand) also bans direct-to-consumer advertising for prescription drugs. Such was the case here too, until 1997, when pharmaceutical companies persuaded the F.D.A. to remove its long-standing prohibition.

All those other countries have it right, and we don’t. Doctors spend precious minutes of ever-shorter office visits explaining to patients why their cholesterol drug is every bit as good as the one they saw on television, or why feeling sad at the death of a loved one doesn’t require an antidepressant. Hawking medications to the public encourages rapid adoption of new products that may be no better — or even worse — than older, unadvertised generic drugs.

Read more… That happened with Vioxx, whose $100 million direct-to-consumer advertising budget drove its use by 20 million Americans before it was found to nearly double the risk of heart attack or stroke. Since this advertising promotes only the most expensive products, it drives prescription costs up and also encourages the “medicalization” of American life — the sense that pills are needed for most everyday problems that people notice, and many that they don’t. A few of these ads have some educational value, but it would make more sense for a neutral body to offer this information (about heart disease prevention or erections) rather than have messages hawking one particular product. Who would pay for that? The same people who end up footing the bill for direct-to-consumer advertising now: the American public. Unfortunately, the genie is probably out of the bottle on this. The industry and its allies in Congress will whine about the First Amendment to defend their right to advertise, and will probably win. Nor is taxing those ads likely to survive a legal challenge. Our best hope is for a newly emboldened F.D.A. to require the companies to provide a much fairer depiction of risks and benefits in these ads — something that is clearly within its power. But as long as the nation spends $2 on these drug ads for every $1 spent on the agency regulating the industry, this combination of promotional incontinence and federal impotence will continue to generate considerable depression.

Other Ways to Promote a Brand

Robin Raj is the founder and executive creative director of Citizen Group, which focuses on developing pro-social marketing campaigns. Clients include Amnesty International, Cisco, the Natural Resources Defense Council and Rock The Vote.

Drug advertising functions the way most television advertising does — that is, marketers promote their products largely at a surface level. And therein lies the reason and moral imperative to do better.

Pharmaceutical manufacturers spend billions to hawk their pills ($4.8 billion last year, according to Nielsen) to drive brand awareness and memorability restrained only by mandatory Food and Drug Administration disclaimers to avoid liability. But selling, say, Cialis like soap isn’t necessarily in the public interest.

Current pharmaceutical advertising is nothing more than one-way directed spin.

Can it be harmful? Potentially. Is it good for us? Not really. The drug makers in general rarely make more than shallow attempts at consumer education. Their efforts are primarily driven by the profit motive, not the health motive. So why are we paying the bill for their ads while the drug companies receive taxpayer subsidies? This fact strikes me as particularly galling and appalling given the immense health care issues this country faces.

Read more… I actually believe drug companies could do well by doing good if they took a more active role in promoting health prevention and wellness through nontraditional, more targeted and contextual media. They could build brand awareness, goodwill and perhaps greater trust if they financed more community-based efforts, online and on the ground, in an open and transparent way. Current pharmaceutical advertising is nothing more than one-way directed spin. While it will never substitute for a doctor’s advice, deeper information — and creating an open channel for conversation and connections about the health topic and the drug itself — could go a long way toward providing transparency and true education, even illumination about one’s health condition. This, and requiring a trial period for drugs that are introduced to the market before deploying massive broadcast budgets, would stand in stark contrast to the current practice of merely driving demand for drugs, for conditions we may not have even known we had.

Entertaining but Out of Control

John Mack is the editor and publisher of Pharma Marketing News and Pharma Marketing Blog.

The topic of direct-to-consumer advertising is a never-ending source of fodder for me, as well as other bloggers. I’m especially fond of those silly ads that feature dead presidents, beavers and bees. Very entertaining indeed, but are they educational? Not on your life!

The industry pushes the envelope by overstating benefits and playing down the risks.

Supporters of this type of advertising often cite the educational benefit it provides to potential patients. Indeed, a speaker at a recent industry conference raised the ante on the educational merit of these ads by suggesting that we “look abroad,” where there are no such ads, and “measure the health literacy to see the potential impact.”

I took the challenge, did some research and found a report that compared health literacy in the U.S. and in Canada. Canadians scored significantly higher than Americans.

Does this destroy the educational argument in support of direct-to-consumer advertising? Not necessarily. There is a difference between health literacy and being “educated” about a drug.

Read more… As for doing harm to consumers, I only need to quote the F.D.A.’s recently released “Draft Guidance on Presenting Risk Information in Prescription Drug and Medical Device Promotion,” which states: Consumers have preconceived ideas about the amount of scrutiny these ads undergo. Many believe F.D.A. exercises tight regulatory control over the content of these ads and to some extent, believe that all ads have been prereviewed prior to airing. As a result, consumers are likely to expect that the most relevant risks have been included in the ad. I am not against prescription drug advertising, but it’s hard to defend it when the industry pushes the envelope by overstating benefits and playing down the risks. That has got to stop.

The Vioxx Scandal

Greg Critser is the author of “Fat Land,” “Generation Rx” and the forthcoming “Eternity Soup.”

In his lone dissent from the 1976 Supreme Court case that enabled drug companies to advertise, Justice William Rehnquist observed that “the societal interest against the promotion of drug use for every ill, real and imaginary, seems to me exceptionally strong.” It would be hard to find a better example than the case of Vioxx, the Merck pain killer.

The F.D.A. should use its powers to slow down blitz campaigns and attend to the ‘societal interest.’

Vioxx, a COX-2 inhibitor, was originally approved for use by a small but important group of pain sufferers: those who had sensitive stomachs. Yet Merck’s multimillion-dollar ad campaign went much further, repeatedly asserting in ads and media coverage that Vioxx was also better at controlling pain than existing (inexpensive) anti-inflammatories. It wasn’t.

And so the skating star Dorothy Hamill was drafted for a new campaign promoting Vioxx for osteo-arthritis. “This is my favorite time to skate,” Ms. Hamill declared in one Merck ad, swirling on the ice. “But it’s also the time when the pain and stiffness of osteo-arthritis can be at their worst.”