Sunday, August 10, 2008

Should the US Ban Prescription Drug Ads to Consumers?

Earlier this year, Pfizer, the maker of a popular cholesterol lowering drug Lipitor was forced to pull its ads featuring artificial heart inventor Dr. Robert Jarvik as its spokesperson. Many people who viewed the commercial believed he was recommending the drug as a practicing physician. But although he is an MD, he does not have a license to practice medicine and write prescriptions so it was agreed to pull these misleading ads.

Even though the Jarvik ads are long gone, more and more people are questioning US laws that allow direct-to-consumer (DTC) advertising of prescription drugs. Although we are now accustomed to nearly endless commercials on TV for prescription drugs, many of us are unaware that every other industrialized country in the world (with the exception of New Zealand)
bans consumer ads for prescription drugs. And even New Zealand is considering a ban.

Are prescription drug ads a good idea? Before answering this, we should think about why certain drugs are only available by prescription to begin with. Unlike over-the-counter (OTC) drugs that relieve less serious conditions that don’t normally require doctor visits, prescription drugs treat conditions that are serious enough to require a doctor’s diagnosis before knowing what to prescribe, if anything. If indeed a drug is needed, sometimes an OTC drug may well be good enough. And if a drug must be prescribed, a conscientious physician should not only select the most effective drug for the diagnosis but also the most cost-effective one if there is a choice.

At least that’s the way it’s supposed to work. But the problem critics see with advertising prescription drugs directly to consumers is that it totally short-circuits this process. To begin with, recommending a particular prescription drug requires the commercial to persuade the consumer of a diagnosis of a condition that their drug will treat (even if they have to make one up). Once that is done, the commercial can then move on to recommending the particular brand of drug the person watching the ad really needs to have.

So the results are that more patients are going to their doctors with the diagnosis they got from the TV ad along with the name of the drug they need to have. Of course the physician can (and should) try to override this with his or her own good judgment. But persuasive drug ads can create powerful brand loyalty even among those who have never even used the product! This can create a dilemma for the physician — risk a confrontation with the patient and the possible loss of business or give in to patient demands even if it is not in the best interest of the patient.

But just to help clinch the deal in their favor, the drug companies have a couple of aces in the hole. For one, they can legally ‘educate’ physicians on the virtues of their brand by way of dinners, trips, or other entertainment. And then there are those free samples that the physician can hand out when the patient requests a certain drug. Once the patient uses the drug in the free sample, they are very unlikely to ever want to change even if less expensive alternatives like generics are available. Generics are never available as free samples (nor are they advertised) because of their much lower selling prices compared to drugs that are still under patent.

Since inexpensive generic drugs do not get the advertising exposure that name brand drugs receive, many consumers do not know of these alternative options when they are available. In the Lipitor example above, the advertising campaign was to build customer loyalty to Lipitor which is still under patent and hopefully keep people from switching to a very similar cholesterol lowering drug, Zocor which is now available as a far less expensive generic drug.

The price of the drugs aside, perhaps the biggest objection to prescription drug ads centers on the newer approved drugs. Even drugs that are approved by the Food and Drug Administration (FDA) for sale can have unexpected and serious side effects that are not discovered until widespread usage of the product reveals them. Perhaps the most famous example is
Vioxx which due to Merck’s aggressive ad campaign resulted in as many as 80 million people using this drug before it had to be withdrawn due to the disclosure of increased risk of heart attack and stroke by its use. To make things worse, the FDA has sometimes taken several months to react to drug ads that were misleading. By then they ad may have already been pulled and done its damage.

The pharmaceutical industry has been under a great deal of scrutiny over their marketing practices. For those interested in exploring this issue in more depth, this
series of video links provides some most compelling viewing.

To help the public with unbiased advice on prescription drugs and other health issues,
Consumer Reports Health offers its Ratings for subscribers but also has a number of articles available for free. Please be sure to check out their AdWatch videos critiquing a number of prescription drug commercials. And Consumer Reports Best Buy Drugs is available as a free (and valuable) public service.

Not to be left out, Saturday Night Live offered its own commercial for a fake birth control pill,
Annuale — a spoof of a real drug ad for Seasonale.

I along with many others feel that since prescription drug advertising does considerably more harm than good, we should seriously consider
an outright ban on these consumer ads like most of the rest of the world has already done. But whether things will change will probably depend on who wins this November. Any change will require more government regulation of the pharmaceutical industry and in general, Republicans favor less regulation while Democrats tend to favor more regulation when they feel it is necessary. And while many have expressed their outrage at oil company profits, the pharmaceutical industry has been the most profitable of all US businesses — and they have shown their willingness to use that money to intensely lobby Congress to keep the status quo. The question is — are enough of us willing to stand up for what we feel is right?

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