Healthy Skepticism Library item: 7815

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Russell J.
Rx for drug ads
The Indianapolis Star 2007 Jan 21
http://www.indystar.com/apps/pbcs.dll/article?AID=/20070121/BUSINESS/701210351

Full text:

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It all started 11 years ago with a curious television commercial showing people traipsing through a meadow.

The ad, for Claritin, never mentioned what the drug was for, leaving viewers guessing what they should see their doctor about. But plenty of people asked. And doctors wrote plenty of prescriptions. Sales of Claritin, an anti-allergy drug made by Schering-Plough, surged from $900 million in 1996 to $2.1 billion in 1998, sparking a huge, controversial movement known as direct-to-consumer advertising.

Today, drug companies, including Indianapolis-based Eli Lilly and Co., spend lavishly to advertise drugs for insomnia, migraine headaches, dry eye, brow furrow, fungus, high cholesterol, irritable bowels, arthritis and dozens of other maladies.

But the huge advertising tide, worth about $4 billion a year, might be turning as a chorus of critics accuse the drug companies of using the ads to bring consumer pressure on doctors to prescribe unnecessary and costly drugs.

The industry trade association, Pharmaceutical Research and Manufacturers of America, defends the practice, saying it helps inform consumers and starts “important doctor-patient conversations about conditions that might otherwise go undiagnosed or untreated.”

But congressional Democrats who have criticized the growing ad campaigns are now in power. Although no bill has been introduced to curb drug advertising, many observers expect it to happen.
Many doctors, consumer groups and insurers have pushed for a ban or moratorium on drug advertising. They say the ads are high on emotion and low on information about the drugs and their side effects.

Some doctors say the ads prompt patients to quiz them on all kinds of medicines, saying they saw ads on television that promised to help.

“It seems like everything out there is a miracle drug,” said Dr. Edward Langston, a family physician in Lafayette and chairman-elect of the American Medical Association’s board of trustees. “Patients have an unrealistic idea of what drugs can do, and what side effects they might have.”

Some consumer groups say the advertising is outright harmful to consumers and creates a culture that tries to convince people they are ill. Only two countries — the U.S. and New Zealand — allow direct-to- consumer drug ads.

Two years ago, Commercial Alert, a consumer group based in Portland, Ore., circulated a petition calling for an end to direct-to-consumer advertising. More than 200 medical school professors signed it. Since then, more than three dozen health and senior groups, including the Gray Panthers and the Women’s Health Institute, have signed a similar petition, calling on Congress to ban drug ads.

“There’s a lot of support for a ban on direct-to-consumer advertising, and the Democrats know it,” said Gary Ruskin, Commercial Alert’s executive director.

In a 2005 study by PricewaterhouseCoopers, more than 94 percent of doctors, academic researchers, hospital executives and other health officials said pharmaceutical companies spend too much on advertising.

Drug company spending on direct-to-consumer advertising has increased twice as fast as spending on promotions to physicians or on research and development from 1997 to 2005.

In 2005, drug companies spent $4.2 billion for direct-to- consumer ads. Spending for 2006 isn’t fully tallied, but drug companies seemed on pace for another record year, with advertising spending up 9 percent over 2005, to $4.5 billion, according to Brandweek, a trade publication.
Lilly and its partner, Icos Corp., spent a whopping $116 million in 2005 on direct-to- consumer advertising just for erectile dysfunction drug Cialis, making it the 10th-biggest drug brand in ad spending that year.

Perhaps the best-known Cialis commercial shows a man and woman reclining outdoors in side-by-side bathtubs, watching a sunset. “When the moment is right,” the announcer says, “will you be ready?”
Many of the industry’s television commercials have a soft and fuzzy touch: people romping through meadows, an elderly man blowing soap bubbles with his grandchildren, figure skaters cutting up the ice.

Some don’t even name the drug, just a condition, such as depression. Others name the drug, but not what it can do, or the possible side effects.

The Claritin commercial in 1996 wasn’t even the first direct-to-consumer drug ad. More than a decade earlier, Boots Pharmaceuticals aired the first one when it promoted its prescription ibuprofen medication, Rufen, according to Advertising Age, an industry publication.

What the Claritin ad did was avoid saying what the drug could do, thus skirting a Food and Drug Administration requirement that drug companies had to disclose risks and benefits alike. By not mentioning benefits directly, it could avoid full disclosure of the risks, instead directing patients to ask a doctor about the medicine.

The Claritin ad encouraged other drug makers to follow suit. Spending on direct-to-consumer advertising soared from $12 million in 1989 to $1.17 billion in 1998, according to Advertising Age.
Today, it’s hard to watch an hour of prime-time television without seeing a drug ad.

Some insurers say the commercials raise the cost of health care, because consumers demand a certain heavily advertised brand, even through it might not be any more effective than a generic drug or other alternative. And drugs often are promoted before their effects on a wide population are known.

“I don’t think pharmaceutical companies should advertise to consumers until the drug has been on the market for a period of time, probably at least six months,” said Alex Slabosky, president of Indianapolis health insurer M-Plan. “You need some history on how the drug is affecting people.”
But drug companies, including Lilly, resist any move to ban advertising or even place an advertising moratorium on new drugs.

“We would argue that if one of our new drugs is first in class or best in class, and that physicians and patients might not be aware of it, this advertising might be appropriate, once we’ve educated physicians,” said Lilly spokesman Edward Sagebiel.

Regulators are weighing in, too. Last week, the FDA said it wants to start charging fees to drug companies, a move that would allow it to hire 27 extra employees to screen drug ads.

Currently, the agency has no power to preview ads. It can only levy fines and order drug makers to pull an ad if it determines the ad breaks regulatory rules. Drug companies are prohibited from downplaying side effects or implying a drug should be used for a nonapproved use.

Rep. John Dingell, D-Mich., new chairman of the House Energy and Commerce Committee, has said he will take a hard look at direct-to-consumer ads.

Sen. Edward Kennedy, D-Mass., new chairman of the Senate’s Health, Education, Labor and Pensions Committee, has pushed previously for a two-year moratorium on advertising a drug after its approval.

Even the industry seems to know the tide is turning. A national conference this year on direct-to-consumer advertising, known as DTC, will address those issues head-on.

The conference’s organizers don’t mince any words. Drug companies should start thinking hard about the subject.

“How likely is a DTC advertising moratorium? How can I build a product launch plan that will prepare for such action?” reads one section of the group’s agenda. “What must we do better in our advertising in order to ensure our survival?”

Call Star reporter John Russell at (317) 444-6283.