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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.
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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.
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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.
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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.
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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.
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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.
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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?
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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
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