PHARMA: DTC advertising works; not exactly a revelation!

So I spent far too much of my life trying to figure out the exact impact that DTC drug ads would have on the exact consumer sub-demographic so that marketing could be refined, and consumer segments sliced and diced.  Turns out that was totally unnecessary.  All you have to do is to get the patient to say the name of the drug in front of the doctor and think that they might have an associated symptom and the doc is only to happy to get them out of the office with said script. 

And it’s good for a five-fold increase in prescriptions compared to patients who don’t ask for it by name. The hidden persuaders don’t need to be that hidden!

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  1. A Television is Not A Medical School
    We often see advertisements on television for some type of medication — usually one involved in a large-market disease and the commercial is sponsored by a big pharmaceutical company. This is called direct to consumer (DTC) advertising, and doctors would prefer they did not exist.
    Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of these commercials greatly increased. Now, the pharmaceutical industry spends around $5 billion annually on this gigantic media effort. Normally, the commercial airs within a year of the drug’s approval, which raises safety concerns and involves money spent that could be applied to greater uses, according to many. But, we are dealing with a corporation here.
    The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective — to increase sales and grow their market — in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. The most interesting ones are for erectile dysfunction (ED) during primetime TV, with the real possibility of children watching. Further surreal is that these particular commercials seem to have ED sufferers portrayed as those who could probably run marathons, which is not realistic from a clinical perspective.
    DTC advertising is also a catalyst for and similar to disease mongering. Disease mongering is the creation of what some believe to be medical flaws. It is illustrated by the drug companies through exaggeration and embellishments via various media sources as an avenue for propaganda — often seen with DTC advertising. Though the flaws may not be medical, the corporate creation of these questionable human ailments that do not require treatment, possibly, may be an attempt to develop a particular medical condition to acquire profit.
    One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. It is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments being advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
    Also, DTC ads normally discuss a single treatment option when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the physician, as they assess your health, not your TV or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of America and New Zealand.
    Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professionals remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. After viewing a DTC ad, many seek out a doctor visit and request whatever product that was advertised, which makes the doctor’s situation quite cumbersome. So the doctor and patient relationship is altered in a negative fashion since most DTC advertised drugs require a prescription.
    Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some of our over-prescribing habits, which will benefit all of us in the long term. And the health care system can regain control of its purpose, which is far from financial prosperity.
    Men of ill judgment oft ignore the good that lies within their hands till they have lost it.
    — Sophocles
    Dan Abshear

  2. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new when something old or generic would do the job for cheaper.

  3. DTC (direct-to-consumer) Advertising is one of the most controversial practices the drug industry uses to market its various products.
    Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Direct-to-consumer campaigns generally begin within a year after the approval of a product by the FDA.
    Supporters of this form of advertising, which is banned in nearly almost all countries (excluding the United States and New Zealand) say it provides a real service to consumers, informing them of new drugs and alerting them to health problems they may be unaware of.
    Critics feel this form of advertising promotes only the most expensive new blockbuster drugs, when older and cheaper versions of drugs might be just as effective, thus driving up overall health care costs, with much emphasis placed on the high costs of prescription drugs.
    Aggressive promotion can pay off big time. Merck, maker of Vioxx, the most promoted drug, spent $161 million advertising it in 2000, and sales of Vioxx quadrupled to $1.5 billion.
    In fact, Merck spent more advertising Vioxx, according to NIHCM (National Institute for Health Care Management Foundation), than the $125 million spent promoting Pepsi or the $146 million spent on Budweiser beer ads. It even came close to the $169 million spent promoting GM’s Saturn, the nation’s most advertised car.
    The drug industry says its ads not only educate consumers but also prompt people who might otherwise go undiagnosed to see their doctors. Many doctors agree.
    What’s your opinion as to whether or not prescription drug advertising costs are a direct reflection to the high costs of prescription drugs in the United States.

  4. //actually depressed and in need of a prescription?//
    LOL – I was just thinking about this after watching the Lorraine Bracco depression treatment ad. On the other hand, I suppose most actors would hesitate to chemically “treat” any extremes of feeling because strong emotion can contribute to their development of their craft. I seem to recall reading a number of interviews where actors I particularly respect discuss depression and how they tap into it for their art. I’m also under the impression that a lot of actors see therapists to deal with the stresses of unstable unemployment and to better understand their feelings. I’ve always wondered how actor (at least the non-A-list ones) actually afford to see therapists on a regular basis. Does actor’s guild insurance pay for therapy?

  5. “The other thing about using actresses is that there are usually an awful lot of folks following that profession who need the work. ;)”
    How does the study account for actresses who – having failed to break into the business except for the random DTC study – are actually depressed and in need of a prescription?

  6. The other thing about using actresses is that there are usually an awful lot of folks following that profession who need the work. 😉

  7. // I blame the obesity epedemic on people eating too much and not exercising enough//
    Eating too much and not exercising enough are certainly major factors, but these factors shouldn’t rule out the possibility of other ones. I’m not suggesting the SSRI story is as simple as Bad Pill Causes Weight Gain. For one thing, women gain weight for years after they stop taking SSRIs: those that I know about just regard an SSRI prescription as the turning point. A more complex explanation might be that SSRI’s cause metabolic changes that are hard to recover from – requiring more exercise than a normal person is likely to put in. Gaining weight in itself can cause fatigue, which decreases the motivation to exercise. Perhaps when the supply of SSRI’s is cut off, the body gets physiologically depressed whether a person feels depressed or not, too. There could be any number of strange chemical chain reactions.
    It can also be argued that bad diet and lack of exercise caused both obesity and an actual expansion of mental disorders, and the prescription of SSRIs just mark the fact that obesity makes people depressed, and depression fosters obesity. I think that’s the assumption that’s either hindering or complicating research into the role the SSRIs themselves might play. From what I know of the experiences of actual people, though, the SSRIs seem to be playing a role. There does seem to be repeated experiences of normal weight maintenance for years (even while depressed), with rapid weight gain after taking SSRIs, and difficulty escaping the metabolic trap after that.

  8. Am I the only one who enjoyed the use of actresses in this study? I have to admit that I’ve asked my doc about prescribing me advertised drugs just to gauge his reaction 🙂
    I think the lesson here is that drug companies should hire and deploy an army of actresses to determine the “prescribing potential” of their target docs. No more free lunches and “educational seminars” in warm locales for those who don’t “respond to the needs of patients”…
    PS I blame the obesity epedemic on people eating too much and not exercising enough

  9. Ads do influence people a lot, but I have to admit that I’ve asked for a specific drug, “or one in its class” that wasn’t being advertised but had been discussed a lot on an internet support group.

  10. Re: Packard – I actually think there is some status that accrues from taking SSRIs. There is a lingering popular association between mental disorder and exceptional sensitivity, dramas of harm/grief/loss, an implied request for special protection from attack, and an aura of genius. Mental disorder is a distinguishing mark, a personal style, and undergoing treatment for mental disorder establishes that you had the disorder in the first place.
    I don’t deny the reality of chemical imbalances, though I think that factors such as diet, environment, and social condition influence physiological changes. I think the expanding ranks of the self-proclaimed mentally ill is something society should be paying attention to. I think it’s a sign of problems that need to be addressed and that can’t just be ignored. If this is driving the health crisis, then it’s in everybody’s interest to start listening and responding to the problems of their neighbors.
    Actually, I think I’m sounding more like Susan Sontag than Vance Packard.

  11. I think this is a step in building my case about the link between the pharmaceutical ads and the healthcare crisis. To recap my theory:
    1. Pharma ads promote expanding diagnosis and pharmaceutical treatment of depression (and other “mental disorders).
    2. Pharmaceutical treatment of mental disorder plays a significant role in the obesity epidemic, causing more health problems (and more prescriptions). If anyone knows of research linking SSRIs in particular to obesity, please let me know. Another thing to look at is “female hormone balance”. The research I’ve seen is ambivalent – usually treating weight changes as a side issue, so my theory is still just resting on anecdotal evidence from people I know.
    3. Both the media-driven demand and the proliferating obesity-related health problems increases the cost of health care. The demand puts health providers at a disadvantage when negotiating for the cost of drugs. Furthermore, mass demand and large populations suffering from standard “chronic conditions” drives investment in technology to handle large numbers of people.
    It seems to me that most pharma ads are taking advantage of social stresses and barraging people with the message that they should feel personally guilty about being a “problem” and will only be regarded as responsible and worthy human beings if they take drugs. When people choose to believe that message instead of trying to address the social problems, they tip the first domino in the chain that leads to the health crisis. It seems to me here that the irony is the attempt to make individuals internalize social problems actually results in bigger social problems for everyone.