Tuesday, November 18, 2014

This Is Your TV On Drugs

Zyrtec used to have commercials that really bugged me.
Someone would sneeze, and everyone would stare at them
with disdainful looks. The message, take this medicine and
stop being a nuisance to polite society. That’s how drug
commercials work, any image to push you toward their drug.
If your prescription for an erectile dysfunction or diabetes drug has to come from your doctor, then why do the drug companies spend all that money on TV ads? 

Because they work! The United States is one of only two countries that allow direct to consumer advertising (DTCA) for prescription drugs. Can you guess the other? These days, there are 100 or so commercials for drugs on the TV every hour of every day.

The practice began in the States in 1985, but didn’t take off until 1997. In ’85, the FDA said it was OK to make claims and not discuss every side effect if the name of the specific drug was not mentioned in the ad. Seldane was the first success using this form of TV advertising. But the claims were so specific that when a person showed up at the doctor’s office asking about it, only one drug, Seldane, fit the description. Sales for Seldane went from a few million dollars to over 800 million dollars.   

In 1997 the FDA decided to let the commercials state the name of the drug without having to give every side effect associated with the drug. Only the major side effects had to be mentioned. And the gold rush was on. Prior to DTCA, the drug companies spent major money to push the doctors to prescribe a certain drug (and they still do), but with the TV commercials, they could actually pull a drug to success by having the patients go ask for it.

Using 2011 statistics, every dollar in DTCA advertising leads to at least four dollars in sales, which is why you’re forced to watch a couple in separate bathtubs on a hill smiling about their sex life. It just pays too well – drugs that use DTCA are prescribed 9x more often than those that are not advertised.

Some people argue that the ads are helpful – power to the people! They may bring more people to the doctor for routine screening and help the patient to see the doctor as a partner, not the boss. They encourage dialogue between the patient and the health provider, where it used to be a one way street – the doctor told you what to take and you either did or didn’t.

Abilify uses animation to sell their drug. The blue robe
represents depression. You take the drug and you don’t have
to wear the robe and it gets depressed. But the robe is always
there, looking creepy. It scares you into staying on their drug.
Some also profess that DTCA leads to a reduction in the stigma attached to certain illnesses, especially mental illness. However, this might not be so. A recent study suggests that DTCA’s for mental illness drugs actually increase the stigma associated with mental illness amongst the general population, while reducing the stigma only amongst the people that actually have mental illness. I’m not sure how helpful that actually is.

The idea that more information is better for the consumer is only true if the information they are getting is accurate and complete. This is where DTCA might have its biggest problem.

A 2014 study rated commercials based on how truthful they were. If they had no exaggerations or false claims, they were termed objectively true. Others were considered misleading, while the rest contained one or more falsehoods. Eighty-four ads for prescription drugs and 84 for over the counter (OTC) drugs were assessed.

The study found that 60% of prescription drug DTCA’s were misleading or false, and the OTC drug ads were worse, 80% contained exaggerations or falsehoods. The most common offender – erectile dysfunction drugs.

The misleading claims are not accidental; they always seem to skirt the bounds of legality. Everything is designed to promote good feelings toward the drug. For example, the study found that when Claritin was moved from prescription to OTC, the beneficial claims in the ads went up six fold.

Maybe the most obnoxious part of the ads is the list of possible side effects read at the end. Who decides what side effects have to be listed? The FDA says that the drug’s most important risks have to mentioned verbally, preferably in language the consumer can understand. Every side effect has to be easily available to the consumer. When the ads say, “Talk to your doctor,” that’s them fulfilling this obligation.

Women take Rogaine (minoxidil) for hair loss, not just men. There
is a whole industry and web community that has cropped up
about how to handle the unwanted hair growth associated with
taking the drug. Too bad that wasn’t there for the women taking
minoxidil for high blood pressure in the 1980's.
The major risks are side effects are those that represent the most severe reactions - death, physical debilitation, and cancer, NOT those that occur most often. True, possible death should be almost always be mentioned, but what about some lesser effects – some people might consider them major.

For example, a drug prescribed in the 1980’s and 90’s for high blood pressure is now marketed for something completely different. Do you think women that took minoxidil for their BP considered it major when they started growing more hair and began to take on the appearance of Kathy Bates in this season’s version of American Horror Story?

You’d think that the drug companies would hate having to use precious ad time to list side effects, but they actually like it. A 2014 study shows that when people are shown ads that don’t list side effects and ads that do, they have better feelings (trust) for the ads that list side effects.

Initially, the side effect lists have a negative effect, but with more viewings, people tend to tune out the side effects themselves. This leaves them only with the feeling of trust they have built up because the manufacturer was “honest” with them. Therefore, they trust those drugs more, but they don't really know why. But we know from above studies that the claims and statements aren’t always completely honest, so it isn't necessarily a justified feeling of trust.

Urban legend has it that the producers added a glimpse of the severed
arm in Star Wars in order to push their rating from G to PG.
But, no, they just asked for the PG rating. Come to think of it,
was there any Star Wars movie that didn’t include the severing
of an arm?
The FDA is thinking about combating this psychological effect by reducing the amount of information that has to be stated. They feel that too much side effect info might be confusing the consumer, leading they tune it out.

Interestingly, consider that the drug companies might not want to reduce the side effect information. They might continue with the long explanations even if not forced to. Did you know that Star Wars asked to have a PG rating so that it could draw a bigger audience that would assume there was more edgy content? Same concept here - they want to spend time on side effects to get the trust pay off.

BTW, the other country that allows DTCA’s for prescriptions drugs – New Zealand, of course!

Contributed by Mark E. Lasbury, MS, MSEd, PhD
As Many Exceptions As Rules

Faerber, A., & Kreling, D. (2013). Content Analysis of False and Misleading Claims in Television Advertising for Prescription and Nonprescription Drugs Journal of General Internal Medicine, 29 (1), 110-118 DOI: 10.1007/s11606-013-2604-0

Steinhart, Y., Carmon, Z., & Trope, Y. (2013). Warnings of Adverse Side Effects Can Backfire Over Time Psychological Science, 24 (9), 1842-1847 DOI: 10.1177/0956797613478948

Corrigan, P., Kosyluk, K., Konadu Fokuo, J., & Park, J. (2014). How Does Direct to Consumer Advertising Affect the Stigma of Mental Illness? Community Mental Health Journal, 50 (7), 792-799 DOI: 10.1007/s10597-014-9698-7

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