Turn on the television to watch the news or the game and you’ll find programming punctuated by advertisements for prescription drugs. These ubiquitous drug advertisements interrupt your video and music streaming, pop-up on websites, and play over the radio. With multiple drugs being marketed for depression, bipolar disorder management, arthritis relief, and “male enhancement,” we are so inundated with prescription pharmaceutical advertisements that we fail to recognize the ramifications these ads have on our culture and healthcare system. Most countries have bans on direct-to-consumer pharmaceutical advertising (DTCPA) dating back to the 1940s (Ventola 2011). Meanwhile, in the United States, DTCPA has flourished and is the posterchild of a multi-trillion dollar drug industry. The direct-to-consumer marketing has proven very fruitful for pharmaceutical companies; studies have shown that the prescription rates of drugs advertised directly to consumers “rose by 34.2%, compared to only 5.1% in other prescriptions” (Sheehan 2003).
The advertising of prescription medications clearly has an enormous impact on which drugs enter the bodies of millions of Americans. This begs the question: Is this the best advertising model for the health of our nation? There are a myriad of opinions on what the legality and restrictions of DTCPA should be and lobbyism continues to obfuscate the debate. It has become increasingly difficult for regulators to determine what the role of advertising in pharmaceuticals should be in order to create the most perfect state of healthcare. However, it seems that in its current form, the largely unregulated DTCPA industry is detrimental to the quality and safety of healthcare provided in America.
Among the primary concerns surrounding DTCPA are the ethical ramifications of largely-unregulated advertising. The FDA is responsible for assuring the safety of prescription drugs and retains discretion over their approval for a reason: prescription medications are “more potent … carry a greater risk of misuse … and have more specific indications” as compared to over-the-counter drugs (FDA 2015). Prescription pharmaceuticals were originally intended to allow restricted access to those with specific conditions and in dire need. However, today it is a trivial task to obtain most prescription drugs, regardless of the drug indications or potential risks. Antidepressants are a commonly cited example of over-prescription. Dr. Ronald Elson of the University of California at Berkeley reports that “over 10.4% of Americans take prescription antidepressants”— a 4% increase from 1999 (Darrow 2015). Dr. Elson attributes this dramatic rise to a number of factors, the most prominent being a combination of DTCPA and patient overload. Patients view advertisements that “can generate a false desire for something that not everyone needs,” leading them to go into their doctor and demand medications by name. Doctors, who “frequently have only 20 minutes or less to see each patient,” are more likely to quickly acquiesce and move on to their next patient. The trend of over-prescription continues across all classes of prescription medication. On a massive scale, people receiving prescriptions for medications that they do not need, misled by direct-to-consumer advertisements hailing their products as the “miracle drugs.”
Before 1986, the pharmaceutical business worked very differently. Pharmaceutical companies would create a product and market it to doctors. When a patient presented symptoms that matched the drug’s indications, they could choose to prescribe the medication as they saw fit. The patient took on a passive role and trusted the doctor’s judgment on which medicine was suitable for them. At the time, introducing a new drug to market was not easy. Each doctor received advertisements for “over 3000 unique pharmaceuticals per year on average,” (Spiegel 2009). It became nearly impossible for companies to differentiate their drugs and break through the sheer amount of advertising noise, regardless of superior efficacy. Achieving market penetration and recuperating their development costs was difficult in such a saturated market. This system ended in 1986 when the pharmaceutical manufacturer Hoechst AG aired the first national direct-to-consumer pharmaceutical advertising campaign for their antihistamine, Seldane; the patient was sold on the medication before ever seeing his/her doctor. Sales of Seldane jumped from “$34 million annually” to “$800 million annually” and virtually all pharmaceutical companies responded by advertising their products in the same manner (Spiegel 2009). It is here that the debate on the legality of DTCPA begins.
Previously, medical doctors screened all pharmaceutical product advertisements and ultimately the doctor chose which medication to prescribe. Medical professionals with years of medical training and experience had autonomy over the treatment process. With today’s DTCPA, patients have taken a more active role in their treatment and now suggest their own treatments. To some extent, this is a positive development as it encourages patients to educate themselves and understand what medications they are taking and why. On the other hand, it is far too common for a patient with no knowledge of potential adverse effects, contraindications, or clinical diagnosis to enter his/her doctor’s office with a mind firmly set on a particular medication, simply based off a television advertisement. In today’s prescription culture, many physicians frequently prescribe medications even if the patient is not an optimal candidate, nor has been formally diagnosed with symptoms matching the drugs’ indications. The pro-DTCPA faction argues that the current state of DTCPA allows for patients to take the initiative and seek out medications to treat themselves optimally—introducing their doctors to medications that they may have not heard of in the pre-DTCPA system. While this may happen in some instances, the sheer number of recorded over-prescriptions since the inception of DTCPA indicates that, in the large majority of cases, patients request and receive medication they do not need. These medications are not always innocuous. Prescription medications are restricted by the FDA for a reason; even in small doses, they can be extremely harmful. US News and World Report cites that on average, each prescription medication carries “70 different possible adverse reactions.” This is especially alarming when one considers that a Mayo Clinic study recently found that “nearly 70% of all Americans are on at least one prescription medication and 52% are taking multiple prescription medications” (Mayo Clinic 2013).
With the rampant over-prescription of drugs, it is inevitable that a statistically significant group of people will be harmed by adverse effects more than they are helped by the medication. Ironically, when these adverse effects are brought to a physician’s attention, it is very common for them to prescribe another medication to treat the adverse effects of the previous medication. Experts refer to these phenomena as a “prescription cascade.” They are symptomatic of deeper, underlying issues surrounding the over-prescription of medications since the inception of DTCPA. As a whole, the high level of DTCPA and its effects on the American healthcare system seem largely detrimental.
In an ideal world, direct-to-consumer advertising would exist only to educate consumers— not to sell product. Patients would be able to gain a comprehensive understanding of the treatment options available to them —options their doctor might be otherwise unaware of (due to the sheer number of medications available)— yet would not go into their doctor’s office mesmerized by advertising. Their doctor would then evaluate the patient’s candidacy for the drug and determine whether a prescription is a good treatment option or not. This would effectively harness the best of both worlds and lead to improved patient outcomes. Such a system would eliminate the prescription cascades that have become so prevalent in the American healthcare system, while granting pharmaceutical companies some freedom and giving patients the opportunity to take an active role in treatment.
Unfortunately, creating advertisements truly meant to educate consumers in a balanced manner as opposed to seducing them with advertising would likely be unprofitable for pharmaceutical companies. Instead we are shown advertisements with celebrities and cartoon mascots selling controlled substances like candy in between phone and car ads. Until we can achieve an ideal form of direct-to-consumer pharmaceutical advertising, America’s healthcare system would be better off adopting regulations similar to the rest of the world, completely prohibiting the advertisement of prescription pharmaceuticals directly to consumers.