Only two countries worldwide allow direct-to-consumer (DTC) advertising of prescription drugs: The United States and New Zealand. Over 20 years (1997 to 2016) DTC prescription drug advertising in the U.S. increased from $1.3 billion to $6 billion “with a shift toward advertising high-cost biologics and cancer immunotherapy” (JAMA Network, January 1/8, 2019). According to the JAMA-published study, pharmaceutical companies bombarded the American consumer with 4.6 million ads in 2016. This includes 663,000 TV commercials (compared to 72,000 in 1997). The authors’ conclusions: “Despite the increase in marketing over 20 years, regulatory oversight remains limited.”
The primary goal of DTC advertising is not one of educating the patient or their family members about a new drug’s potential side effects. The drug company’s message is clear: “Remember our drug’s name and ask your doctor for a prescription.” A 2015 survey by the FDA found that more than half of the consumers questioned said DTC ads did not provide enough information about the risks of taking a specific prescription drug.
Most physicians would probably agree that patient pressure can play a role whenever a prescription is written for a new drug, even when another medication is an equal or better choice. DTC ads focus almost exclusively on “breakthroughs” in other words, high-priced prescription drugs implying that new drugs are better than older, usually less expensive drugs of proven benefit and well-known risk factors.
Prior to the early 1990s prescription drug makers promoted their products almost exclusively to the prescribers of those drugsdoctors who were expected to evaluate and interpret drug information for their patients. By the mid-90s an increasing number of patients began to play a bigger role in making their own health care decisions and doctors began to spend less time with “drug reps.” Over the past couple decades, physician judgment and advice have become less influential in determining the potential benefits of a new drug, especially one being touted by the pharmaceutical company as a breakthrough. In some cases, this may prove to be true. In other cases, even when approved by the FDA, the risks are often found to outweigh the benefits.
As noted above, drug companies spend billions of dollars every year on direct-to-consumer advertising of prescription drugs. The entire cost of processing these ads is a tax-deductible expense for the drug manufacturers. This corporate tax break, however, would be eliminated if a recently introduced Senate bill becomes law; the bill is called The End Taxpayer Subsidies for Drug Ads Act. Although it’s still early in the legislative process, the chance of the bill being enacted is considered “slim.”
Ken Teufel, M.D.