Remember the last time you turned on your television to watch a football game or catch up on the latest episode of American Idol? You saw ads for beer, the latest iPad, and all kinds of prescription drugs aiming to cure everything from psoriasis to cancer. It is almost unimaginable that the same technique that’s used to sell beer is being used to sell life-saving medications. What you tend to forget while watching these ads, is that they are just that—advertisements created to promote Big Pharma products, an industry valued at $435 billion in 2019, according to Frost & Sullivan research. This type of promotion of prescription medication through mass media is known as direct-to-consumer advertising (DTCA).
What unleashed DTCA for prescription drugs in the U.S.? How have life-altering discussions that should only be happening in a doctor’s office moved their way into peoples’ living rooms?
The Prescription Drug DTCA Industry Landscape
DTCA for pharmaceuticals was legalized in 1997. Despite its relatively short 22-year existence, it has heavily impacted the advertising landscape for U.S. healthcare and stands in stark contrast to forms of legal advertising for drugs in other countries around the world. In the face of controversy and questions surrounding the ethics of DTCA, the U.S. and New Zealand remain the only two countries in the world that allow this practice. The U.S. may remain the only one if the draft of the Therapeutic Products Bill in New Zealand manages to include a ban on prescription drug advertising.
While DTCA has some positive effects, these commercials tend to mislead patients and can result in the breakdown of the doctor-patient relationship. Between 1983 to 2013, a span of 30 years, 449 articles about DTC prescription drug ads were published. These articles dissected the various pros and cons of the practice. The pros were primarily based on the belief that when patients saw ads for drugs that aligned with their symptoms, they would start a dialogue with their physician and take a more active role in their healthcare journey. Despite this well-intended strategy, DTCA of prescription drugs has shown the potential to jeopardize the doctor-patient relationship. According to an FDA survey, 65% of physicians said that DTCA for drugs sent confusing messages to the patients, and 8% claimed that they felt pressured to prescribe brand-name drugs after patients cited a DTC drug ad.
The routine use of DTCA and its adverse effects resulted in the AMA taking a stand against this type of advertising. The AMA was concerned that “a growing proliferation of ads is driving demand for expensive treatments despite the clinical effectiveness of less costly alternatives.” The AMA’s stance is representative of the growing skepticism surrounding DTCA in the medical community. If the largest association of physicians in the country is voicing its concerns about this practice, why do pharmaceutical companies continue to use DTCA?
According to the Journal of the American Medical Association (JAMA), there has been a drastic increase in DTC prescription drug marketing budgets, jumping from $1.3 billion in 1997 to more than $6 billion in 2016.; that is a 361% increase. These companies use DTCA to promote prescription drugs because it increases the volume of drugs sold. A 2008 House Commerce Committee found that for every $1,000 spent on prescription drug ads, 24 new patients were added for the pharma industry. Additionally, a 2003 research report found that rates for prescription drugs with ads were almost seven times greater than for those without ads.
In the controversy surrounding high-drug prices, you often hear pharma companies claiming that the drug price hike is a direct consequence of R&D spending. Along with the negative effects on the doctor-patient relationship, this also impacts your wallet. With the misconception of spending, there has to be an industry-wide re-evaluation of priorities regarding DTC prescription drug advertising.
The Advertisement You See
“Who Wouldn’t Want a Chance? A Chance to Live Longer.”
The advertisement released by Bristol-Myers Squibb for Opdivo, a drug for a type of advanced lung cancer, is full of flashy images of open skies and vast planes, suggesting an open road to a healthy future.
Medications for life-threatening diseases as serious as lung cancer cannot possibly be explained or understood in 90 seconds. The side effects that range from fatigue to suicidal thoughts, which you or a loved one may encounter while taking any prescription medication, can be vast and potentially debilitating. It is almost impossible for anyone to understand all the implications of taking a drug from this type of advertisement.
For Opdivo, specifically, the dramatic imagery and bright colors draw the viewer’s attention away from the tiny font at the bottom that states, “This is for adults with non-small cell lung cancer previously treated with platinum-based chemotherapy.” This drug presents itself as a cure for all types of cancer, but it is only used to treat a specific type of lung cancer. Most patients who see this ad do not fully understand the details when asking their doctor about a medication. Without a doubt, these companies know that patients want to find ways to live longer. For someone suffering from cancer, it is not appropriate to fill them with false hope, only to be turned down by their doctor if they don’t fit the criteria. The onus of having this difficult conversation is shifted to the doctor, further straining the doctor-patient relationship.
The oversimplified message in the Opdivo advertisement is not unique; many ads follow the same blueprint. These ads can promote potential misconceptions. Consequently, there has been a significant decline in trust from the American public toward the pharma industry. As of 2018, the Edelman Trust Barometer indicated that 62% of Americans do not trust the pharmaceutical industry. Along with publicly discussed topics like high drug prices and the opioid epidemic, DTC drug commercials have contributed to this lack of trust.
The pharma industry aims to save lives through its medications. Therefore, trust is an essential component that is important to the value of patient health. The value-based care model disrupts the typical “one-size-fits-all” DTC ad and engages with patients in a manner that is more relevant and transparent.
A forward-looking alternative to DTC ads is Disease Awareness Campaigns (DACs) aligned with this value-based care model. DACs are not product specific, and they empower patients to engage with their doctors without focusing on a particular drug.
One company that used DACs is Gilead, a research-based biopharmaceutical company that commissioned a Hepatitis C ad campaign. The ad successfully used the DAC model and encouraged people to get tested without mentioning its product.
Ads using this strategy aim to effectively educate people about their disease, empower potential patients to speak with their doctors, and remove the stigma surrounding the particular disease. While this alternative protects the doctor-patient relationship by allowing doctors to prescribe the best possible medication without patient pressure, there are concerns due to the lack of FDA oversight surrounding this practice.
The pharma industry is a revenue-generating business. While these companies will continue to promote their products to increase shareholder value and profitability, their ultimate responsibility is to people and patient health. The industry needs to commit to marketing strategies that will not only drive a profitable future but promote one that is ethically sound.
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This article was written with contributions from Inayat Gill, Romina Gupta, and Kate Meacham. These women are students at Mount Holyoke College and were highly recognized at the 2019 International Business Ethics Case Competition in Los Angeles, California.
 Schwartz, LM, Woloshin, S. Medical Marketing in the United States, 1997-2016. JAMA. 2019;321(1):80–96. doi:10.1001/jama.2018.19320