I don’t consider myself to be an apologist for the pharmaceutical industry, though in past columns I have tended to defend more than attack them. I have pointed out the need for a reasonable profit margin for these companies in order for them to adequately fund the ongoing research and development of new and better medications. The operative word here has always been “reasonable.”
However, I must now draw a line in the sand, and it has to do with “direct to consumer” advertising (DTC). I don’t know what finally pushed my button, since I have been bothered by these TV commercials for several years. You know the issue I’m talking about – an example would be the Viagra commercial showing a middle-aged man throwing a football through a tire swing. Try explaining that one to your twelve-year-old boy, or your eighty-year-old grandmother.
We see these commercials everyday: nose sprays, arthritis medicine, stomach medications, even medicines to help manage cancer. Now don’t get me wrong here. I’m all for patient education and individual empowerment. But is this really education? And is that what the drug companies are trying to do? Of course not. This is selling, pure and simple. And it’s becoming more and more common, and doing so because it works.
For a moment, let’s consider how this “selling” takes place. Think back to the last drug commercial you watched. I dare say it was emotionally pleasing, with attractive “patients” and an overall positive and wholesome presentation. There was a lot of talk about how effective the medication was for a certain problem. And there was little if any discussion about harmful and significant side effects. What about how this new drug stacked up against older (and cheaper) medicines? And speaking of cost, was that even mentioned at all? Hmm. And finally, one of the most troubling things to me as a physician is the marketing of medications for illnesses that are poorly understood, poorly defined, and for which no specific and effective treatment has been identified. (Fibromyalgia).
Now let’s consider a few numbers. Just how much are drug companies spending on DTC advertising? In 1996 (just after the FDA said it was OK to do this) the annual amount spent was $985 million. Not exactly small change. But by 2005, that number had grown to $4.237 billion. During that same period of time, the money spent on medical journal advertising – getting the information out to physicians – actually decreased. (I guess they figured out who the more important audience is here.)
So just what drugs are being promoted with this kind of money? Here’s the top 10 in dollars spent on DTC advertising:
- Nexium (stomach medicine)
- Lunesta ( for sleep)
- Vytorin ( lowers cholesterol)
- Crestor ( another cholesterol lowering medicine)
- Advair ( inhaled medicine for asthma and COPD)
- Nasonex ( a nasal spray)
- Flonase (another nasal spray)
- Lamisil ( fungal medicine)
- Plavix (a blood thinner, much more expensive than aspirin)
- Cialis ( you know, the outdoor “bath tub” medication)
So where’s Viagra? It’s slipped all the way down to #17, behind Lipitor but just ahead of Prevacid. And here’s something interesting – the spell-checker on my word-processor has red-lined all of these drugs except … you guessed it. Viagra. I suppose it’s become such a household word that they no longer need to promote it.
OK, so these drug companies spend all this money on advertising because they know one thing: it works. The review article noted that for every $1.00 that is spent on DTC advertising, the company will see an increase in sales of $2.20. That makes the math pretty simple. And it’s a simple premise. The viewer sees an advertisement on TV, then goes to their family doctor and asks for a prescription. The physician is pressured to comply with this request, and there you have it.
So what are we to do? I told you that I’ve drawn a line in the sand, but as a physician, I’m really pretty powerless. I will continue to use these medications because they are effective. But I’ll continue to cringe when these commercials air on my television. I suppose that cringing will be tempered by a small measure of amusement. After all, this is only Madison Avenue hoodoo and it’s hard to take it too seriously.
But I’ll still cringe. Maybe you should too.
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