Drug Ads Are Everywhere, But Not Necessarily Good For YouSep 16, 2002 | The Record Channel-surf or flip through a magazine and you might be as likely to see a commercial urging consumers to ask doctors about a certain prescription medicine as to see one hawking beer, clothes, or computers.
Spending on ads for medicines and other remedies ranked fifth among all categories, one of only two in the top 10 to grow last year. Six drug companies ranked among the top 50 advertisers last year. Merck & Co. spent more on consumer ads for its arthritis pill Vioxx than was devoted to Nabisco cookies, Blockbuster videos, or the 10-10-220 long-distance phone ads.
Five years since the Food and Drug Administration clarified its regulation of broadcast advertisements, drug company promotion of prescription drugs to consumers has exploded.
The pharmaceutical industry spent $2.7 billion on promotion directly to consumers, more than triple the amount it spent in 1996, according to IMS Health, an industry information tracking group. Television ad spending was most responsible for the spike, jumping by more than six times since 1997.
That year in August, the FDA issued guidance designed to clarify the requirements for broadcast advertisements for individual products. Observers say the trend toward consumers demanding more information about their health already was spurring an increase in advertising, but the FDA's move greased the wheels, particularly for television commercials.
The spending rise flattened last year, but the attention paid to the topic has not. Regulators, healthcare advocates, and physicians are studying or watching the ads to find out their influence on public health.
Proponents say the ads have satisfied consumers starving for more information about their health. Detractors question whether the ads are leading to inappropriate prescribing and high drug costs.
"We have a social experiment, a public health experiment going on," said Steven Findlay, director of research and policy with the National Institute for Health Care Management foundation, a research organization whose board is largely represented by health plans. Findlay's organization studied the connection between heavily advertised medicines and drug spending, but he said few conclusions have been made about the overall impact of drug ads on public health.
Ads that promote individual drugs are a phenomenon unto themselves. For one, they address people who cannot buy the advertised products without the help of a doctor willing to prescribe. For another, they are highly regulated. Drug companies can only make claims about their products consistent with the prescribing label approved by the FDA.
Ads also must include information about the drug's major health risks. The result is often a surreal juxtaposition: images of smiling people frolicking in bucolic surroundings while a soothing voice lists sometimes frightening potential side effects. Plus, the ads generally must direct consumers to ways to get more information - all in one 30-second commercial.
The drug industry points to these stringent regulations as reason that the spots are more than just advertising. The commercials provide a new source of information that can educate consumers who are increasingly taking charge of their own health, says Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America.
"Direct-to-consumer advertising raises awareness of diseases and conditions that are often undiagnosed or untreated," Trewhitt said.
"We think that it's appropriate for physicians and patients to receive as much information from as many parties as possible."
Ironically, that is exactly the problem with direct-to-consumer advertising - the lack of information it provides to the public, according to Amanda McCloskey, director of health policy for Families USA, a national healthcare consumers organization. In drug ads, consumers are hearing only one side of the story, McCloskey said, a story that leads them primarily toward higher spending and away from potentially less expensive and equally effective alternatives, such as generic medicines.
"We need to be honest about why pharmaceutical companies do this, and they do this to protect their profits," McCloskey said.
One of the main concerns about consumer promotion has been its effect on the doctor-patient relationship, foremost that it would prod patients into insisting that their physicians prescribe a certain drug.
Prevention magazine, a health publication that has studied consumer advertising since 1997, found in its 2001 consumer poll that 32 percent of all consumers who have seen an ad have discussed an advertised medicine with their doctor. A second study - released in November by the Kaiser Family Foundation, a healthcare think tank - supports that number, finding that 30 percent of adults talked to their doctors about a drug they had seen advertised.
Meanwhile, Prevention's study found that that percentage of consumers discussing an advertised medicine with their doctor was virtually the same as in 1997, the year the FDA issued its guidance.
Also stable since 1997 is that 29 percent of those who discussed an advertised medicine with their doctors actually asked for that medicine. Of those, about eight in 10 people were prescribed the medicine. The result is that about 7 in 100 people - TFI an estimated 13.6 million consumers - received a prescription for a medicine they had seen advertised last year.
Ed Slaughter, corporate director of market research for Rodale Inc, publisher of Prevention, said results show "enough activity from the marketers' standpoint to warrant continued support of the advertising." But, Slaughter said, "it's not this sea change that can affect the healthcare system in America in the way some purport it does."
Jack Isaacs, a Hackensack resident who heads a partnership of seniors' groups in Bergen County, would likely not be one of those consumers receiving a medicine because of an ad. Isaacs said he has talked to his doctor about drugs involved in studies he reads about in newspapers or medical newsletters to which he subscribes, but it would be rare that he would bring up a medicine because of an advertisement.
"I rely on my doctor, but I would not be afraid to discuss the medicine," Isaacs said.
Isaacs said he's wary about the ads pushing him away from older medicines that can help him save money. "I feel that there's a profit motive, and I'm most concerned about getting a generic that's cheaper and that the ads tend to work against that," Isaacs said.
Between 1994 and 2000, drug ad spending rose at an average rate of 45 percent a year, according to the Kaiser Foundation. While drug company spending on print ads to consumers has remained basically stable since 1997, by 2000 spending on television jumped by 6
times, from $240 million to $1.6 billion, according to Prevention.
Spending on advertising for prescription medicines still amounts to only one-fifth of the $14.5 billion the biggest advertisers, the automotive industry, spent promoting its products to consumers last year, according to data from Competitive Media Reporting. The same report showed Merck's Vioxx was 82nd among all brands advertised last year.
Still, said David Goetzel, who follows the drug marketing industry for Advertising Age magazine, "for networks and magazines, it's been an entirely new category practically out of nowhere."
"If you watched the evening news with Dan Rather five years ago, the chances are good you wouldn't have seen a single ad for a prescription drug," Goetzel said. "Today, if you told me seven of them are for prescription drugs, you wouldn't blow me away at all."
Bob Ehrlich, CEO of Randolph-based Rx Insight, a company that consults on consumer drug advertising campaigns, said that consumer advertising increases demand by raising awareness of untreated conditions. This is a boon to consumers, Ehrlich said, especially in underprescribed categories such as cholesterol.
"If 1/8sales of3/8 cholesterol drugs have grown 20 percent per year, it's because people who have high cholesterol are taking them," said Ehrlich, who previously worked on the advertising campaign for the blockbuster cholesterol drug Lipitor while at the drug maker Warner-Lambert.
Ehrlich said that the advertising has helped consumers become more aware of side effects of medicines, about which they might not have found out in conversations with their doctors.
Pfizer Inc. said another benefit to advertising is helping patients stay on medicine they are already being prescribed. A study funded by the drug giant found that patients with ailments such as allergy, arthritis, and depression were more likely to stick with their regimen as a result of seeing an ad.
Dr. Robert Rigolosi, president of the Medical Society of New Jersey, agrees that this is a benefit to the advertising. A kidney specialist at Holy Name Hospital in Teaneck, Rigolosi said it has been easier to prescribe Procrit, which replenishes red blood cells in anemic patients, because of the ads for the Johnson & Johnson drug.
"Sometimes patients don't like to take medicines," said Rigolosi. "This is something that helps them to understand this is well-accepted, well-used, and well-advertised and accepted by the community."
For its part, Pfizer, which markets such drugs as Lipitor, Viagra, and Zoloft, seeks to give patients enough information so that they want to ask their doctor about the medical condition and any potential solutions they have heard about, said Dorothy Wetzel, the company's senior director for consumer marketing.
Unlike selling cookies or cars, Wetzel said, success for drug ads cannot mean only selling your product. "That can't be the only endgame," Wetzel said. "This is a different type of business, and we take that difference seriously."
For its part, the American Medical Association advocates that members keep an eye on consumer ads.
The association's guiding policy urges doctors to resist commercial pressures to prescribe advertised drugs and to ensure that patients not get false expectations about a product.