Over the past 20 years, a major new expense in the health-care arena has been the drug advertisement
directed at consumers. These ads attempt to convince consumers that a drug they are currently not taking
is worth using.
Drug companies are spending billions of dollars trying to persuade individuals actually trying to persuade
individuals to persuade their doctors to prescribe a particular drug. Whether these advertisements are
beneficial in promoting awareness of illness or harmful in creating convincing people they are ill, prompting
a demand for unnecessary drugs, is as yet unsettled. What is clear is that the advertisements work.
Most people agree that the development of prescription drugs has been one of the great triumphs of the
past 100 years. As a primary care doctor, I write many prescriptions with the hope that at least some
of my patients feel better as a result. But as the recent Medicare debate in Congress highlighted, prescription
drugs are expensive most of the costs are paid for directly out of pocket. Prescription drugs account
for roughly 10 percent of national health-care costs.
Until the mid-1980s, pharmaceutical manufacturers marketed their products almost exclusively to physicians.
And let's not forget there were, and still are, major problems with those promotions. Doctors were bribed
by attractive "sales people" who visited their offices and offered the doctors fancy trips, gifts, dinners
at elegant restaurants and the like.
But society changed. The nature of the doctor-patient relationship changed. Patients wanted to be involved
in their own care and make decisions themselves. So in 1985, the FDA allowed the pharmaceutical industry
to advertise directly to the public as long as they abided by existing standards for fair and balanced
reporting of benefits and risks. A new marketing approach was born and, with the huge investment from
pharmaceutical companies, advertising agencies went wild creating effective promotions.
Direct-to-consumer (DTC) advertisements work in a number of ways. The ads seek to increase recognition
of hidden existing diseases. By describing worrisome symptoms or outlining potentially bad outcomes, these
ads encourage patients to seek medical attention for symptoms that might otherwise have been overlooked
or neglected. But these techniques often "medicalize" trivial conditions, such as dandruff, or normal
signs of aging, such as baldness. In both cases, the goal is to get patients to seek attention for conditions
that they previously considered benign or natural. The ads also seek to make their product sound remark
able compared to other existing treatments. The goal is to get patients using one drug to switch to another.
What do doctors think of DTC advertising? Not much. While some recognize that DTC advertising has the
potential to increase awareness of symptoms or treatments, most see only the more negative aspects of
these promotions. Patients ask about ads that encourage them to focus on trivial somatic complaints
or cosmetic anomalies, leading to unhealthy bodily preoccupation and inappropriate use of health services.
The ads often lead to physician-patient conflict as a result of the doctor's unwillingness to prescribe
an unnecessary or costly drug. The patient leaves the office dissatisfied and disrespected.
In the midst of all this uncertainty, what are we to do? At the very least we should ensure that DTC
ads are accurate and balanced. Because the market has not enforced these standards, the government will
have to do it. But the current FDA has not taken this task seriously. For example, in a five-year period,
the FDA issued 156 warning letters to drug companies in 1998 for overly aggressive marketing tactics,
compared with only 56 in 2002. Without congressional pressure applied to the FDA, I am afraid nothing
will happen. Isn't it time the FDA begins to work in the best interest of the American people and help
us all promote a healthier world?