Marketing of Drugs to the Public

Several years ago, I posted an article expressing my belief that advertising by attorneys and physicians was unprofessional and encouraged the basest instincts of the practitioner. http://www.associatedcontent.com/article/167745/advertising_by_attorneys_doctors_is.html? singlepage=true&cat=17

While it is too late in the day to Bar advertisements for legal and medical services, there is no question that such advertisements need to be strictly regulated. In that article, I noted the reasons for strict guidelines and regulation:

An attorney specializing in personal injury cases should be allowed to advertise his or her availability to represent victims of automobile accidents; similarly, an attorney who specializes in workman’s compensation law or estate and probate cases or bankruptcy law, should be allowed to tell the public of his or her experience and availability. The last time I checked, one legal encyclopedia listed over 600 separate fields of law and no attorney can be expert or even proficient in all of them. Advertisements are a logical way to advise potential clients of the practice.

The same concept applies to physicians. There are hundreds of specialties and sub-specialties in medicine. A physician should be permitted to advertise his or her area of practice and competence.

However, where I find fault with my occupy profession is the advertisement which infers that there is a causal connection, always, between an injury and a person’s or institution’s negligence. To advertise to parents whose child has had a birth defect that there must have been negligence on the part of doctor or hospital is, in my opinion, cruel and false. Sometimes, bad things simply happen. Sometimes unpleasant results can occur with the best medical care. An automobile crash is not always a matter of the sole fault on one party’s fragment. The injury that results during the utilize of a particular product may or may not be a case of product liability. The injured person may just be dumber than dirt and the cause of his own injury.

In the Tampa telephone book are advertisements aimed at frightening people. One advertisement for a bankruptcy firm asks if the potential client “is tremulous to acknowledge the telephone . . . afraid that you may be sued, go to jail, and lose your home? ” For a remarkably reasonable fee, those fears can be assuaged.

Physicians are not free from criticism. There is a plastic surgery center advertised in the Tampa telephone directory as, “the Fountain of Youth Institute”. Another doctor has in his waiting room a billboard announcing, “Miracle of the Week”. I am intrigued by the surgeon who advertises, “Gentle Touch Vasectomy.” I would hope so.

To some extent, the advertising of prescription drugs directly to the public has the same potential for abuse. In addition, it is virtually certain that such advertising is a cause for increased health care and drug costs.

The first Federal regulation of drug advertising was in 1906 with the passage of the Wiley Act which gave the Food and Drug Administration authority to regulate drug advertising to prevent “adulterated or misbranded” drugs, defined as

… all medicines and preparations recognized in the United States Pharmacopoeia or National Formulary for internal or external use, and any substance or mixture of substances intended to be used for the cure, mitigation, or prevention of disease of either man or other animals.

The 1906 law was subsequently repealed and replaced, with major legislation in 1938 and 1962. Advertisements from the nineteenth and early twentieth centuries were evidence that regulation was needed. In 1895, the Lloyd Manufacturing Company advertised “toothache drops” laced with cocaine; in the following year, advertisements for “Mrs. Winslow’s Soothing Syrup for Children Teething” were common. The syrup’s primary active ingredient was morphine. And, at the turn of the century, the Bayer Corporation advertised in the New York Medical Journal promoting the company’s brand of heroin!

Ten years ago, the FDA issued its Guidance for the pharmaceutical industry on direct-to-consumer (DTC) advertising of prescription drugs through broadcast media when it released its industry guidance document [http://prescriptiondrugs.procon.org/sourcefiles/guidance_for_industry_1999.pdf]. The 1999 guidance document described how companies could make “adequate provision” of prescription drug packaging information in broadcast media advertisements without directly disclosing the more detailed risk information that must accompany print advertisements. According to testimony before Congress, direct-to-consumer advertising increased retail sales of the 25 most popular drug categories by 12%. The top five were antidepressants, drugs to lower cholesterol, proton pump inhibitors (acid reflux/heartburn), nasal sprays, and antihistamines. For every $1.00 spent on advertising, pharmaceutical retail sales increased by $4.20. Not a bad return on its money!

In 2007, the pharmaceutical industry was estimated to be spending $4.8 billion dollars a year advertising prescription drugs directly to the public. This is, of course, in addition to the extensive, and often controversial, direct marketing to health care providers. See, for example, http://www.associatedcontent.com/article/228464/free_gifts_to_doctors_may_be_bad_for.html? cat=12

In 2008, the sale of prescription drugs was a $291 billion dollar a year business in the United States. While there is little question that inflated drug prices in the United States have exacerbated the health care delivery system problems, there is also the issue of promoting duplicate and redundant drugs.

There are interesting, and often compelling, arguments in favor of or in opposition to speak to consumer advertisements. Those, including naturally the pharmaceutical industries, who feel that such advertisements are important and vital to the educating of the public, assert that prescription drug advertisements utter consumers about potential medical conditions they may have and about drugs that could help treat those conditions. This could lead to the reader’s contacting his or her doctor to discuss the condition or related drugs.

On balance, however, I would urge that the value of direct to consumer advertisements is not worth the potential adverse effects.

Advertisements and marketing to physicians provide an efficient plan of advising health care professionals of new drugs, new techniques and treatments and, in many cases, are accompanied by readily available peer review in medical journals. A trained health care professional has the background and education to evaluate new pharmaceuticals and treatment procedures and to best evaluate the material.

Dispute to consumer prescription drug ads, like most advertisements, are intended to sell the product being advertised. These ads employ marketing tactics that manipulate, create false impressions, and otherwise have the potential of misleading consumers instead of educating them about the drugs. Not only can these advertisements cause people to pick medicines based on the effectiveness of the advertisement rather than the effectiveness of the medication but also induce patients to want and request medications that might be unnecessary or even harmful, thus leading to an over-medicated and unhealthy society.

Often the direct advertisements advocate drug utilize as a significant response to medical conditions that can often be remedied in other ways such as diet, exercise, stress reduction, and other preventative measures. Medical professionals are placed in a difficult position whereby they may lose patients if they refuse to prescribe drugs that their patients have seen on television and now want. They cannot be blamed if some physicians may sign prescription requests just to keep their patients happy and coming back, thereby becoming “rubber stamps” for patient requests and adding to drug manufacturers’ profits.

It would be far better to rely upon a physician in whom one has trust. As a personal mark, I am truly weary from watching cured for the disease d’jour, whether it is erectile dysfunction or PMS or whatever is in fashion.