Turn on the television. Between episodes of your favorite show, you will inevitably find yourself flooded by pharmaceutical advertisements urging you to buy their products with claims such as “three times more effective than the leading brand-name product,” or even more convincing, “number one doctor recommended.” Use of commercial marketing techniques has grown widespread within the pharmaceutical industry as a method of targeting not only the public, but also the physicians, whose decisions in particular require careful and unbiased analysis. Disastrous consequences can result if a doctor inappropriately or superfluously prescribes a drug because he or she has been persuaded by a misleading advertisement. As one physician, David Healy, described earlier this month at an annual meeting of the American Psychiatric Association (APA), “The big problem is that if you ask for data, [the pharmaceutical industry] can’t give it to you. That’s not science, that’s marketing masquerading as science.”1 When it comes to health, the patient, not profit, should be the priority. Consequently, drug companies should place higher emphasis on providing accurate rather than persuasive information in their advertisements.
Studies in 2004 showed that pharmaceuticals aimed 87% of their marketing efforts at physicians, an unsettling portion of which tend to take place outside the public’s eye.1 According to Dr. Paul Applebaum, president of the APA, “94% of psychiatrists in training have already accepted a ‘small noneducational gift or lunch’ from a drug company,” and 34% of psychiatrists have also confessed to being biased after receiving gifts. This value is likely even higher, given that the data was self-reported and only concerns a portion of the total doctors with prescribing power.1 Free samples, which totaled 16.4 billion dollars in 2004 and have shown to increase the number of brand-name drugs prescribed and to raise costs without improving accuracy, are also used by companies to promote their products.1,2 It would appear that the drug industry is less concerned with improving patient care and more concerned with widening profit margins, regardless of the possible detriment to the patient.
Lacking prescription information can lead to consequences such as those reported recently in the New York Times. Fluoroquinolones, antibiotics intended to treat serious bacterial infections like hospital-acquired pneumonia, became the subject of over 2000 lawsuits last year when they were misprescribed by “lazy doctors […] trying to kill a fly with an automatic weapon” for patients with sinusitis and bronchitis.3 Patients developed debilitating side effects such as widespread weakness, acute kidney failure, and retinal detachment, symptoms that should have been apparent during clinical trials. Whether due to abbreviated research or intentional concealment of data, the fact that these drugs were distributed to and accepted by the public in the first place indicates an emphasis on rapid output rather than the quality of the product and reliable data.
Perhaps the key question here is how much blame should be laid on the drug industry, and how much on incompetent doctors. After all, it is at the doctor’s discretion that drugs like fluoroquinolones are prescribed for patients, and perhaps it is as foolish to blame the drug company as it is for an obese consumer to blame McDonalds for its tempting Big Macs. Nevertheless, one is hard-pressed to exonerate the drug industry. Data has undeniably shown an increasing frequency in the number of pharmaceutical advertisements, and one must ask why an industry would put so much effort and money into marketing if no benefits are reaped. Placement of these ads is telling as well. A study published at the end of August this year showed that the proportion of pharmaceutical advertisements in a leading oncology medical journal had increased from 24.0% to 49.8% between 2005 and 2009.4 This indicated a shift in target populations of pharmaceutical advertising from the public to physicians. Moreover, another study from August 2011 investigating the adherence of pharmaceutical advertisements in medical journals to FDA guidelines described “content important for safe prescribing [to be] often incomplete: 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification.”5 While the study was limited by subjectivity of FDA guidelines and determination of its adherence, the question remains: If doctors were not presented with correct or sufficient information, how could one be surprised that they were uninformed?
The solution should thus be clear: to tighten federal regulation of pharmaceutical advertisements, both for prescription and over-the-counter (OTC) drugs. The latter is necessary since the Federal Trade Commission, not the Federal Drug Administration, oversees advertising of OTC drugs, and these are even more likely than prescription drugs to withhold information regarding potential harms.6 By allowing the government to filter out bad ads and more strictly monitor the facts presented, such as eliminating relative statistics in favor of absolute numbers and verifying that statements are accurate and based on recent data, we can ensure that the public is well-informed about their pharmaceutical options. While stringent regulation may discourage companies from marketing their products, lead to fewer ads, and consequently limit public knowledge of new prescriptions, less misleading information will increase overall awareness of these drugs and their full effects. It may even be wise to limit public drug advertisements to over-the-counter only, since prescription drugs are chosen not by the patient, but by the doctor, and direct-to-consumer advertising only adds patient bias. One could say that such a measure would restrict personal freedoms when it came to choosing prescription medications. But if accuracy and quality of patient care are improved, can one really argue against an outcome that favors the patient’s health?
Health care is not a business and should be clearly distinguished from such. We must discourage marketing techniques that skew our opinions and the opinions of our experts, especially with so many lives at stake.
- Szalavitz, Maia. “TIME: Health & Family.” TIME. 5 Oct 2012. (accessed Oct 20, 2012).
- Lin, Swu-Jane. “Frequency Estimates from Presc.” 15, no. 7 (2006): 512-520. (accessed Oct 20).
- Brody, Jane E. “Well.” The New York Times Company. 10 Sep 2012. http://well.blogs.nytimes.com/2012/09/10/popular-a (accessed Oct 20, 2012).
- Yonemori, Kan. “Content Analysis of Oncology-R.” (2012): (accessed Oct 20).
- Korenstein, Deborah. “Adherence of Pharmaceutical Ad.” (2011): (accessed Oct 20).
- Greene, Jeremy A. “Changes in Direct-to-Consumer.” 308, no. 10 (2012): 973-975. (accessed Oct 20).
- Image credit (Creative Commons): e-MagazineArt.com. “Pills 3.” Flickr. Last modified June 27, 2010.