Although government spending cuts to health care and entitlements are often attributed to the declining state of the medical system, a significant factor affecting Americans’ health choices is often overlooked: direct-to-consumer (DTC) advertisers. Spending on prescription drug marketing geared toward consumers has grown exponentially over the years, detrimentally affecting the health care system by planting presupposed ideas of treatment into the collective consumer psyche.
While advertising of prescription medication has existed in the U.S. since the early 1700s, it was often restricted to physician-directed advertising in consult or medical journal advertisements. Only in the 1980s did pharmaceuticals begin to push for a marketing campaign geared toward consumers, citing public education as their impetus. Not until 1997 did policy shift to allow pharmaceutical manufacturers to advertise a drug’s name and associated conditions without disclosing all of the product’s risks and contraindications.
With these changes, DTC advertising surged. While pharmaceuticals only spent $12 million on consumer advertising in 1989, DTC spending reached $1.3 billion in 1998. By 2007, DTC spending reached $4.8 billion and has become a factor to blame in the rising costs of prescription drugs. Not only has there been an increase in absolute spending, but also an increase in the percentage of pharmaceutical sales spent on DTC, which jumped from 14.2% in 1996 to 18.2% in 2005.
The effect of DTC advertising since 1997 has been colossal. A 2010 survey commissioned by the AARP found that 90% of Americans age 18 and older have seen or heard one or more prescription drug advertisement, and that 10% of these respondents have asked their doctor for the advertised drug. Of those who do visit the doctor’s office, more than a third either received a prescription for the advertised drug (41%) or received a free sample (27%). On the television alone, recent studies place the amount of exposure to DTC prescription drug ads at 16 hours per year for the average American.
How is this volume of advertising affecting your health?
Vioxx provides an example. This miracle anti-inflammatory was marketed heavily by Merck, with over $500 million in DTC ads for the drug. The drug was pulled in 2004 after being linked to an increased risk of heart attacks with prolonged use; an estimated 88,000 to 140,000 cases of heart disease have been linked to the drug. Today, it is regarded as one of the most widely used drugs to be pulled from global consumption, in addition to one of the most controversial, considering the mounting evidence of its lack of safety several years prior to its shutdown.
The benefit of these DTC advertisements with respect to public awareness of medical conditions and treatments also remains questionable. A 2006 study on consumer-targeted prescription television ads found that in a collection of 103 distinct advertisements, just over a quarter described condition causes (26%), risk factors (26%), or prevalence (25%) of a disease. None of the ads mentioned lifestyle change as an alternative to products. These ads minimize risks and overstate the benefits, skewing consumers’ perceptions. Furthermore, DTC advertising is disproportionate for a certain number of drugs, with the top 20 advertised drugs in 2000 accounting for an estimated 60% of all spending on direct-to-consumer advertising.
While the FDA maintains that there is tight regulation to ensure the accuracy of the findings presented in drug ads, the number of letters sent by the FDA to pharmaceutical manufacturers has declined drastically. These letters that notify manufacturers of advertising violations, such as risk minimization or exaggerated effectiveness, fell from 142 in 1997 to 21 in 2006.
All of this has resulted in a pharma-driven, patient-demanded market, where consumers have a distinct idea of their prescription of choice, before even stepping foot in the doctor’s office. As such, primary care physicians are pressured by patients to prescribe advertised drugs, posing significant health risks.
With the exception of New Zealand and the U.S., every country in the world has banned direct advertising of prescription medication to consumers. Until advertisements are better regulated and standardized in terms of educational quality, the U.S. should also ban DTC ads for needlessly promoting prescription drugs and minimizing the role of physicians in the health advisement of patients.
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