Drug advertisements have come a long way
Direct-to-consumer advertisements for prescription drugs have been legal in the United States since 1985, but are illegal in almost every other country. The history of consumer-directed ads in this country is that of private companies replacing public agencies as the purveyors of information on prescription drugs to the people. It has left us in a strange landscape—one that involves the rights of patients, the rights of private businesses, effects on health, and the multi-billion-dollar industry of drug ads today.
Many medical providers worry that drug ads give incomplete or incorrect information. One analysis of advertisements show that while 82% of ads contain factual information—such as symptoms for a condition—26% included risk factors for the condition and only 19% mentioned lifestyle changes. The majority used emotional appeal to sell their message, with 95% going positive and 69% going negative. And patients trust drug advertisements more than you might expect. Half of surveyed consumers believe that all drug ads are approved by the government and 43% believe that advertised medications must be safe.
While opponents view drugs ads as potentially harmful to the public’s health, defenders cite patient empowerment through knowledge, the rights of businesses to advertise to the public, and the assertion that revenue generated for pharmaceutical companies goes back into research and development for new drugs. But perhaps the biggest public health reason to defend drug ads is that it drives patients to physician offices: 27% of patients who saw a drug ad reported making a doctor’s appointment. Another study found that drug ads lead to a positive spillover effect—patients who saw an advertisement for a brand-name statin were more likely to get any type of statin. And in a Medical Care article from last year, researchers found that statin advertisements drove both statin prescribing and outpatient visits among younger adults.
Another argument by defenders is that even if patients request a certain prescription because of an ad, the provider will only prescribe it if it is medically indicated. That is true… to an extent. In a survey of cancer nurse practitioners, 74% reported getting requests for inappropriate medications from patients and 43% felt pressured to prescribe regardless of appropriateness.
In another study, actors portrayed new patients presenting to primary care physicians with symptoms of adjustment disorder, which is usually treated with psychotherapy. Patients who requested an antidepressant by name from an ad were five times more likely to get a prescription than patients who just requested any medication. Interestingly, the same study showed that patient-actors who presented with symptoms of depression were more likely to get an appropriate prescription if they requested a specific drug seen in a TV ad.
Spending on drug ads is substantial, and it’s only getting larger. In 2017, total spending on consumer-directed ads was about $5 billion. In 2010, the budget for drug ads among all pharmaceutical companies was double that of the FDA—the sole agency responsible for regulating all of these ads.
It makes sense that drug companies would invest so much. Every $1 spent on a television broadcast ad generates between $2.20-4.20 in sales. It’s even more for ads on social media, with every $1 bringing in an estimated $5 in sales. On top of that, money spent on advertisements is not taxed, adding another incentive.
The ethics of consumer-directed ads ultimately comes down to a question of information asymmetry. There is a wide knowledge gap between patients and providers that ads claim to help bridge. But who is better suited to educate the public—a for-profit corporation or a healthcare system? Or perhaps the better question is, who is better equipped—a company with vast financial resources and expertise, or an overburdened workforce?
The average American sees as much as 30 hours of drug ads per year, compared to fifteen minutes or less spent interacting with a primary care physician at each visit. Can corporations be trusted—or incentivized—to provide objective information to a distracted public? Is that even what the public wants?
These questions will only get more complicated as the FDA starts to grant expedited approval processes for certain drugs and explore allowing off-label marketing. In the current climate, few ads actually comply with federal rules. As long as drug ads do exist, it is necessary that the government has the resources and authority to regulate them and protect the public’s health.
Eunice Zhang