The sleeping giant woke up in 2015…sort of. The American Medical Association (AMA) is the largest organization of physicians in the U.S. At its interim meeting seven years ago, the AMA called for a ban on drug ads. The press release from the AMA back on November 17, 2015 stated:
“’Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,’ said AMA Board Chair-elect Patrice A. Harris, M.D., M.A. ‘Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.'”
What Happened to the Ban on Drug Ads?
Have you seen any concerted effort by medical societies to pursue a ban on drug ads? Didn’t think so. We have not seen any campaigns to put an end to this travesty. The FDA is certainly not lobbying for a ban on drug ads.
Our senators and representatives in Congress are clearly not rushing to initiate a ban on drug ads. They take a lot of money from the pharmaceutical industry. Want to know how much? Go to OpenSecrets.org. Here is what we found when it comes to 2022 “Money to Congress” from “Pharmaceuticals/Health Products.”
210 Democrats in the House received total contributions of $8,151,130 (average contribution = $38,814)
200 Republicans in the House received total contributions of $6,442,961 (average contribution = $32,214)
47 Democrats in the Senate received total contributions of $4,574,423 (average contribution = $97,328)
50 Republicans in the Senate received total contributions of $2,644,538 (average contribution $52,890)
Do you wonder why our senators and representatives might not want to alienate the hands that feed them.
Prescription Drug Commercials on TV:
If you watch any television at all you have almost certainly seen a commercial that urges you consider drugs such as:
- Dupixent [for eczema, asthma]
- Rybelsus [for type 2 diabetes]
- Humira [for psoriatic arthritis, Crohn’s disease, ulcerative colitis, hidradenitis suppurativa or HS]
- Ozempic [for type 2 diabetes]
- Trulicity [for type 2 diabetes]
- Rinvoq [for eczema, rheumatoid arthritis]
- Jardiance [for type 2 diabetes, heart risk]
- Skyrizi [for plaque psoriasis]
Informal polls that we have taken show that most people find these ads aggravating at best and horrific at worst. Nonetheless, it is clear that this type of marketing is working.
Why Doctors Find TV Drug Ads Annoying.
Most physicians we have talked to also find commercials for prescription drugs offensive. They never imagined that patients would come into their office asking for powerful prescription drugs to treat serious medical conditions like type 2 diabetes or lung cancer. Trying to explain why one of these new medicines might not be right for you could be aggravating and time consuming.
An editorial in JAMA (Feb. 7, 2023) notes that doctors have complained about drug ads for a very long time:
“The tension between physicians and drugmakers, especially over marketing, dates to the era of patent medicines. Since 1997, pharmaceutical manufacturers have advertised directly to US consumers, amplifying controversy over the role of drug marketing in clinical care. Critics argue that direct-to-consumer advertising drives use of expensive medications of marginal or no benefit. In 2015, the American Medical Association called for it to be banned.”
Should we try to encourage a ban on Drug Ads?
The editorial above by Dr. Amanda Starc is in response to a research paper in JAMA (Feb. 7, 2023). The authors introduce their research this way:
“The US and New Zealand are the only countries that allow direct-to-consumer advertising for prescription drugs. From 1997 to 2016, spending on advertisements for prescription drugs directed to consumers in the US grew from $1.3 billion to $6 billion, with the greatest increases observed among drugs to treat diabetes and endocrine conditions.”
This study compared the effectiveness of advertised drugs to the advertising budget.
The authors concluded that in general, companies spent more money promoting drugs with less clinical benefit than for those with higher clinical benefit. This paid off. Higher advertising budgets resulted in greater sales of medications with lower benefit. Creating consumer demand through advertising appears to drive prescribing of drugs that doctors might not prioritize.
Pharmaceutical manufacturers are now spending a large proportion of their promotional budgets for top selling drugs on patients rather than physicians. It is also possible that such direct-to-consumer advertising also influences physicians. They do watch television after all.
Perhaps it is time for prescribers to pay more attention to clinical benefit rather than TV commercials.
PhRMA’s Support for Drug Ads:
The organization that represents most major drug companies, Pharmaceutical Research and Manufacturers of America (PhRMA), responded to the 2015 news release from the AMA by telling Bloomberg:
“Providing scientifically accurate information to patients so that they are better informed about their health care and treatment options is the goal of direct-to-consumer pharmaceutical advertising.”
Getting Around FDA Rules About Drug Ads:
The FDA requires drug companies to reveal the most serious side effects of the medications they advertise to the public. Ad agencies have found ways to make the messages less scary. One of the most common tactics is to show pictures of people having fun, smiling or playing with dogs or children during the voice-over about severe adverse reactions.
Abilify TV Commercial:
As an example, consider an ad for the antipsychotic drug aripiprazole (Abilify). It was being promoted as an add-on to an antidepressant. The announcer read:
“Abilify is not for everyone.
“Call your doctor if your depression worsens or if you have unusual changes in behavior or thoughts of suicide…
“Elderly dementia patients taking Abilify have an increased risk of death or stroke.
“Call your doctor if you have high fever, stiff muscles and confusion to address a possible life threatening condition or if you have uncontrollable muscle movements, as these can become permanent. High blood sugar has been reported with Abilify and medicines like it and in extreme cases can lead to coma or death.
“Other risks include increased cholesterol, weight gain, decreases in white blood cells which can be serious, dizziness on standing, seizures, trouble swallowing and impaired judgment or motor skills.”
While this long list of side effects was being read, the cartoon woman interacted with her smiling cartoon character colleagues at work and then served lemonade to her smiling cartoon family at a backyard barbecue. It’s hard to focus on life-threatening drug complications when everyone seems to be having such a good time.
The Disconnect Between Death and Happiness:
Next time you are watching television and a prescription drug ad begins, we have an experiment for you to try:
First, turn the sound down on your television so you cannot hear a word and just watch the commercial. We suspect that you will come away with a strong sense that the medicine being advertised makes people healthy and happy. Most drug ads are really upbeat.
Next, when the same drug ad shows up, close your eyes and just listen to the words so you can actually hear the side effects and warnings without any visual distractions. Chances are good that you might hear: one or more of the following:
seizures, loss of hearing, difficulty breathing, agitation, hallucinations, thoughts of suicide, trouble swallowing, muscle pain, chest pain, high blood sugar, severe liver problems, swelling of your tongue or throat, heart attack, stroke, lymphoma, cancer, tuberculosis, heart failure, coma or death
All of a sudden drug side effects will seem more serious if you aren’t watching people playing with a dog, frolicking in a park or swimming in a lake.
What Can You Do To Encourage a Ban On Drug Ads?
Now that doctors have come out against prescription drug ads, the American public could join them in calling for a ban on drug ads to consumers. Remember, the U.S. and New Zealand are the only “advanced” countries that allow this sort of thing.
Let Congress know that you are sick and tired of prescription drugs ads and that the AMA is on the right side of this issue. The cost of medicine is high enough without adding objectionable commercials to the price patients have to pay.