Imagine you have an amazing office visit with Dr. Wunderbar who offers the following:

unequivocal confirmation that the symptoms you’ve been experiencing actually represent an accepted disease with a real name

studies, statistics, and even anecdotes from other patients validating your experience

help in finding discounted prices for the proven treatments you’ll need

enough time to answer any and all questions you might have, and says “call me or my nurse anytime for more information … we’re here for you”

Clearly, Dr. Wunderbar is wonderful.

Problem is — there is no Dr. Wunderbar.

But there are plenty of drug websites that offer all this and more — using the slickest of graphics, videos, and eye-catching statistics — and without having to deal with that crowded waiting room, stodgy doctor, and ho-hum degrees on the wall.

Direct-to-consumer marketing of prescription drugs was approved (New Zealand 1981, US 1997, and Brazil 2008 ) — for the most part — before the internet emerged as the most far-reaching marketing tool of our time. After all, the internet is in our office, home, car, phone, and even our wristwatch.

It has proven to be a target-rich venue for the pharmaceutical industry, and one they have capitalized on with techniques that are sometimes informative but can also be manipulative, misleading, and even potentially harmful.

Let’s look at a few drug websites to see what sort of strategies are commonly employed and how they can be hazardous to your health.

The fab five features of drug websites

About a week ago I wrote a story about the only FDA-approved drug to treat a condition called pseudobulbar affect, or PBA. That drug is called Nuedexta and — like so many new drugs that pharma companies are heavily invested in — it has its own website: www.nuedexta.com.

The website is a virtual blueprint for the 5 marketing tools I see most commonly used to hook customers (pharma would likely counter they are 5 tools to “educate”). Here they are:

Heavy reliance on patient anecdote videos (ironically, using actors more than real patients … because convincing trumps realism, I guess) Cherry-picked statistics (usually from studies that place their treatment in a positive light and are often carried out by researchers on their payroll) A financial saving/support or “Co-Pay Calculator” (implying you don’t have to pay full cost … if you qualify) Quizzes or FAQ sections which encourage you to self-diagnose (the threshold for meeting the diagnostic criteria is almost always incredibly low) A call to action = “ask your doctor” (even though they just encouraged you to self-diagnose and they’ve probably already visited your doctor’s office pitching their samples)

The primary goal of these websites is not hard to spot. They are clearly trying to expand the pool of people who are eligible to be diagnosed with the condition their drug treats. The companies will counter that this is simply an attempt to identify the “undiagnosed.” But, it not only increases the demand for their drug, but also runs the huge risk of diagnosing people without the condition. For example, I took the Neudexta quiz and it looks like I may have pseudobulbar affect:

And here are the 7 questions, of which I answered “occasionally” to all 7 — because that’s my honest reply. Of note, had I answered “rarely” to all 7 questions … I would have scored >13 and still been considered a possible candidate for PBA:

“The veneer of charity & corporate philanthropy”

After convincing you that you may have a disease — or that you need their medication for the condition you’ve already been diagnosed with — it’s typical for drug websites to offer a helping hand in paying for their drug.

Financial support tabs (or “co-pay calculators”) are on most drug websites and seem harmless enough. But Alan Cassels, a drug policy researcher at the University of Victoria and a regular contributor to our blog, says that’s not necessarily the case:

“Co-pay or coupon programs have the veneer of charity and corporate philanthropy but they are only giving ‘deals’ on marginal newer drugs, when there are often cheaper and more effective generic drugs available — like metformin instead of Farixa. Also, once a patient enters one of these programs they become a data point. You’ve now established a direct line between the drug company and the patient. Patients can become dependent on that company for their supply of drugs. And the company can turn around and use your data for further marketing, patient reminders, gifts, and other types of largesse.”

Cassels goes on to point out that most of these drugs are usually third line treatment options. In other words, clearly not the safest, most affordable, or most effective drugs available.

“If a drug isn’t worth taking,” says Cassels, “then making it cheaper doesn’t make it any more attractive or worthwhile.”

And as veteran health care journalist Trudy Lieberman wrote on this blog, what on the surface may look like a win-win — with patients paying less and drug companies gaining a loyal customer — actually shields us from knowing the true price of the drugs. While a select few patients may see savings, the high cost of the drug will be shifted to someone else.

Disclaimer: Bette Davis’ eyes weren’t dry … but they might have been

I can’t tell whether this Allergan website for “Chronic Dry Eye” disease — or CDE — is incredibly sexy, bizarre, or ingenious.

It’s called “Eyepowerment” and uses a video (soundtrack is the song “Bette Davis Eyes” popularized by Kim Karnes in 1981) featuring famous women to inform us that: “Before We Had Our Voice, We Had Our Eyes.” After a parade of recognizable faces we’re told: “Burning, itchy, dry eyes may send the wrong message. These are symptoms of Chronic Dry Eyes.”

We’re led to believe this is a “medical disease” when it’s actually a symptom associated with some very serious illnesses. And it affects a lot of people. How many?

Well, in 2014, Allergan said 20 million people were affected by CDE. In 2015, it was 25 million people. This year it jumped to 33 million people. And one ophthalmologist (who in 2015 made over $33,000 consulting for Allergan and other companies) claims over 60 million people worldwide may suffer from CDE.

Why this matters

Drug companies have a business to run. So what’s the matter with using these 5 common strategies to reach consumers? Let’s answer that question with these questions:

Does a video featuring actor portrayals or famous people — peppered with biased statistics that may come from weak studies or paid researchers — actually do more to inform or entice? Could it misinform or actually convince people they have a disease that they don’t have, or isn’t really a disease in the first place?

Is it appropriate — or even ethical — to tailor a FAQ section or quiz to maximize the chances that the result suggests you have an illness that requires a drug to treat it? This, despite knowing full well that the drug carries medical and financial risks.

What business does a pharmaceutical website have diagnosing (or, encouraging patients to self-diagnose) problems without a medical degree?

These websites are high budget and very sophisticated. They can be visually stunning and — when you combine that with the effective tactics mentioned above — they have tremendous potential to influence both medical opinion and health behavior. All the more reason that we as consumers need to stay wary of both their intent and content.

Why? Because these sites can be hazardous to your health … just “ask your doctor.”

Correction by author: I incorrectly wrote that Brazil approved direct-to-consumer marketing of prescription drugs in 2008. That is not true. The country only allows direct-to-consumer marketing of over-the-counter drugs … as well as cosmetics and herbal medicines. This is regulated by ANVISA. Thanks to Dr. Addi Faerber of the Dartmouth Institute for catching this!