Drug Advertising: Only in America

June 22nd, 2005 by

The Insider has occasionally wondered about the thought process that leads a doctor to prescribe a specific medication for a particular injury. We are intrigued by the continued popularity of Oxycontin, which, even with its track record of abuse and addiction, is still the one of the most popular pain killing drugs in the workers compensation system. We wonder how drug companies influence the decision-making of doctors. How do they get inside the doc’s head?
Today we explore an easier question to answer: How do drug companies get into the heads of consumers? An article in today’s Los Angeles Times (registration required) explores the impact of direct advertising on consumers and discusses a growing backlash against these drug ads.
New Speech
Drug advertising to the general public is a $4.5 billion dollar industry — and a fairly new one at that. The FDA has permitted these direct appeals only since 1977. It is interesting to note that the U.S. is the only country that permits pharmacy companies to bypass doctors and go directly to consumers in their search for increased market shares. So every day we are bombarded with images in the media: wonder drugs that will lower cholesterol, control diabetes, improve sex lives, grow hair, cure flatulance, conquer depression and presumably, enable us to live forever.
For whatever reason, drug ads appear to work. A Kaiser Foundation survey in 2001 found that 30% of Americans had spoken to a physician about a specific medication they had seen advertised. Of these, 44% reported that they came away from the doctor with the prescription they asked about. These numbers have probably gone up since the survey was completed. This might be good — assuming that the ads increased consumer awareness of real medical problems. Or it might be bad — assuming that harried doctors wrote the scripts to satisfy their customers.
Doctors and public health officials are increasingly wary of the impact of advertising on American medicine. They fear that the advertising leads to the widespread use of costly brand-name medications, in many cases by people who don’t really need them, or who should not take them, or people who might achieve the same result with more established and less expensive treatment.
The Vioxx Story
Vioxx, developed as an arthritis drug, was touted through a $300 million ad campaign between 2000 and 2001. It is probably not a coincidence that in 2002 it was the third most prescribed drug in the workers compensation system — prescribed, I would note, not for its original use in arthritis (which is not work related), but for pain. In September 2004 Vioxx was removed from the market due to “increased risk of cardiovascular events” — industry speak for “heart attack.”
After eight years of increasingly aggressive advertising, even the pharmacy industry is having second thoughts. Or it might be more accurate to say, the industry, anticipating a backlash from doctors and regulators, is taking steps to voluntarily limit advertising. There is no way they will agree to a total ban — once the door was opened to advertising, it will prove impossible to shut it completely. If you are interested in the industry’s own perspective, one of their lobbyists resides here. It’s a matter of “free speech” — although I often wonder why “free speech” costs billions of dollars…
AMA Study
The American Medical Association, perhaps recognizing the political realities, has stopped short of requesting an outright ban on drug advertising, although many of their members would probably like to see one. (You can be sure that most doctors do not appreciate their patients showing up with a diagnosis and drug solution in hand!) The AMA has set up a study committee to explore the impact of advertising on treatment. It will be interesting to see just how radical a position the AMA eventually stakes out.
In the meantime, I look forward to tracking the industry’s self-imposed reforms. I will certainly keep my eye out for more balanced ads, carefully scripted scenarios which emphasize education about symptoms and which balance the positive effects of the drug with cautions about any potential side effects. I do have a vague suspicion that the new ads will be indistinguishable from the old: curing every possible ailment, real and imagined, making the user indescribably happy and promising the good life forever.