The Corpus Callosum

And what an unflattering light it is. 

It occurs to me that often, when I write about the pharmaceutical
industry, I have something negative to say.  Really, my thoughts
are not all negative.  It’s just that it is easier to come up with
criticisms when responding to news items. 

Anyway, this one (from Washington Post) deserves comment:

href="http://blog.washingtonpost.com/thecheckout/2007/01/drug_ads_taking_medicine_never.html">Drug
Ads: Taking Medicine Never Looked So Good

Remember all those tricks drugmakers used to get you to take medicine
as a kid? They made cough syrup sweet and acetaminophen chewable. They
transformed horse pill vitamins into friendly cartoon characters.

Well, perhaps a better approach would’ve been to inundate you with
ads–ones that depict a fearful and alone child who becomes happy,
confident and popular after taking a pill.

That formula, it seems, works well on millions of Americans, who watch
as many as 16 hours of prescription drug ads every year — far more
than the average time spent with a primary care physician…

That is an interesting point, that the companies get more time to make
their case than the doctors do.  Other versions of the same story,
in other publications are more pointed.  For example, this one,
from Forbes:
href="http://www.forbes.com/forbeslife/health/feeds/hscout/2007/01/29/hscout601397.html">

href="http://www.forbes.com/forbeslife/health/feeds/hscout/2007/01/29/hscout601397.html">Study
Blasts TV Drug Ads
01.29.07, 12:00 AM ET

MONDAY, Jan. 29 (HealthDay News) — In strong criticism of
the pharmaceutical industry’s marketing practices, new research claims
that televised ads for prescription drugs are riddled with emotional
appeals and lack helpful information on the disease itself.

“The ads really use emotion instead of information to promote drugs,”
said the study’s lead author, Dominick Frosch, an assistant professor
of medicine at the University of California, Los Angeles…

…Ninety-five percent of ads made “emotional appeals,” and 78 percent
implied that use of the medication would result in social approval.
Fifty-eight percent of the time, products were depicted as medical
breakthroughs.

Other versions appear in href="http://www.usatoday.com/news/health/2007-01-29-prescription-drug-ad_x.htm">USA
Today and NewsTarget.com
The study that prompted these articles was published in Annals of
Family Medicine 5:6-13 (2007).  The full text is href="http://www.annfammed.org/cgi/content/full/5/1/6">here; the
accompanying editorial is href="http://www.annfammed.org/cgi/content/full/5/1/2">here. 
The authors looked at commercials that aired in prime time on ABC, CBS,
NBC or Fox in 2004. They analyzed 38 different advertisements. 
Their biggest beef with the ads is that they rely so heavily on
emotional appeals, associating positive imagery with their
products.  They know that the images are what people will
remember, along with the positive association to the products. 

I Know from personal experience how effective this is.  It is
fairly common for patients to mention the images in the ads, even if
they don’t remember the product name or anything else. 

In the editorial, Dr. Stange writes:

While ads present facts and rational arguments, almost all
make emotional appeals for their product. The majority of ads portray
medication use as socially approved and as a way to regain control over
some component of life. Few mention lifestyle approaches as a positive
alternative or convey a balance of treatment options…

…Unsaid in the study or editorial is the tremendous intrusion of such
advertisements into the clinician-patient relationship. These ads suck
precious time, motivation, and energy from the patient visit, forcing
clinicians to educate patients about why a slickly promoted drug is not
as important as a less sexy lifestyle change or even a cheaper but
equally effective alternative medication…

Later on, he points out that the issue is complex: 

A recent systematic review concluded that there is good
evidence that direct-to-consumer marketing increases demand, but no
evidence of benefit.7 Other analyzes of the data in the Epstein
study,8,9 however, show a complex relationship between patient demand
and quality of care for a single disease. Patient requests for
antidepressant medication are associated with more depression-specific
history taking, as well as both averting underuse and fostering overuse
of antidepressant medication, without apparently distracting from
history taking for a second musculoskeletal condition presented during
the visit.

That is the most positive thing in the whole article.  The editor
concludes that the use of direct-to-consumer advertisements is “an
unproved public health intervention that raises serious cause for
concern.” 

Of course, the only way to change this would be through administrative
rule changes, or by legislation.  Hopefully, studies such as these
will prompt the government into action.  And after the
administration and legislature clean up the problems with drug company
ads, they should turn the same attention to their own political
ads. 

Comments

  1. #1 Dan Abshear
    October 1, 2008

    Your Television is no Substitute for Medical School.

    We often see advertisements on television for some type of medication — usually one involved in a large-market disease and the commercial is sponsored by a big pharmaceutical company. This is called direct to consumer (DTC) advertising, and doctors would prefer they did not exist.

    Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of these commercials greatly increased. Now, the pharmaceutical industry spends around $5 billion annually on this gigantic media effort. Normally, the commercial airs within a year of the drug’s approval, which raises safety concerns and involves money spent that could be applied to greater uses, according to many. But, we are dealing with a corporation here.

    The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective — to increase sales and grow their market — in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. The most interesting ones are for erectile dysfunction (ED) during primetime TV, with the real possibility of children watching. Further surreal is that these particular commercials seem to have ED sufferers portrayed as those who could probably run marathons, which is not realistic from a clinical perspective.

    DTC advertising is also a catalyst for and similar to disease mongering. Disease mongering is the creation of what some believe to be medical flaws. It is illustrated by the drug companies through exaggeration and embellishments via various media sources as an avenue for propaganda — often seen with DTC advertising. Though the flaws may not be medical, the corporate creation of these questionable human ailments that do not require treatment, possibly, may be an attempt to develop a particular medical condition to acquire profit.

    One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. It is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments being advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.

    Also, DTC ads normally discuss a single treatment option when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the physician, as they assess your health, not your TV or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of America and New Zealand.

    Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professionals remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. After viewing a DTC ad, many seek out a doctor visit and request whatever product that was advertised, which makes the doctor’s situation quite cumbersome. So the doctor and patient relationship is altered in a negative fashion since most DTC advertised drugs require a prescription.

    Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some of our over-prescribing habits, which will benefit all of us in the long term. And the health care system can regain control of its purpose, which is far from financial prosperity.

    Men of ill judgment oft ignore the good that lies within their hands till they have lost it.
    — Sophocles

    Dan Abshear