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As drug companies push their pills over TV, some are asking: Is that good for your health?

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Abe Lincoln, the beaver, and the insomniac in an advertisement for Rozerem. The prescription sleep aid said to be the first of its kind with no demonstrated potential for abuse or dependence during clinical trials. (Courtesy of Takeda Pharmaceuticals North America, Inc.)

Go on vicarious afternoon walks with a smiling Sally Fields, whose energy and bone density has never been better, thanks to a new brand of osteoporosis drug. Sit in on late-night card games with Abraham Lincoln and a sardonic beaver who nudge insomniacs toward a sleep medication with a suggested lower risk of chemical dependency than other prescription sleeping pills.

The ads are entertaining, but should you be influenced by them?

The number of direct-to-consumer (DTC) pharmaceutical ads has exploded in recent years--American viewers watch an average of 16 hours worth of DTC spots a year--and are having measurable side effects. Doctors and others in the medical community are concerned that the ads, many specific in targeting conditions such as insomnia, depression and erectile dysfunction, are turning some consumers into self-diagnosing physicians.

As consumers request specific brand-name drugs from doctors at increasing rates, controversies surrounding promotion of products such as Pfizer’s cholesterol drug Lipitor, suggest that patients may be misguided by these advertisements. That can lead them to demand prescriptions that do not offer the treatment they seek--or worse, may cause them harm.

“You don’t want lay people practicing medicine at home,” said Dr. David Evans, a family physician in rural Madras, Ore. “You want them talking to their physicians about their condition, not about specific medicines that should be used for it.”

Since the mid-1990s marketers of prescription drugs have shifted their strategy from targeting a virtually exclusive audience of physicians, to one that includes the general consumer. An easing of Food and Drug Administration regulations in 1997 has helped bolster marketers’ access to and communication with consumers, permitting ads as long as they state the product name, discuss the ingredients and side effects, and do not mislead viewers.

While the increased exposure can benefit consumers, the consequences can be severe, ranging from disillusionment to potentially fatal side effects. In the case of diet pills Xenadrine EFX, One-A-Day WeightSmart, TrimSpa and Cortislim, marketers were fined $25 million last January by the Federal Trade Commission for false claims of rapid weight loss and lowered risk of osteoporosis, among others.

In another highly publicized litigation, pharmaceutical heavyweight Merck & Co. stands to pay billions in compensation to some of the 20 million Americans who have taken the arthritis drug Vioxx since it debuted in 1999 and have experienced conditions such as strokes and heart attacks. Vioxx was pulled in 2004 but questions linger as to whether advertisements adequately addressed the drug’s underlying risks. While Merck maintains its disclosures were appropriate, consumer protection groups such as the U.S. Public Interest Research Group are skeptical.

Even if ads do adequately disclose risks, they are promoting brand names over other less-expensive drug options.

“There is a germ of truth to ads that educate consumers,” said Michael Russo, a health care advocate and staff attorney with the California Public Interest Research Group, “but they also have a major effect in terms of driving sales.”

The U.S. pharmaceutical industry spent about $575 billion on promotion in 2004--almost twice as much as it did on research and development--according to a study by York University researchers published in the Jan. 3 issue of the online journal PLoS Medicine. Successful advertisements are key to the longevity and profit of brands over generic prescriptions.

Consider the success of Lipitor, the top-selling prescription drug in the U.S. for six years running, according to ConsumerReports.org. An advertisement for the drug asks, “Did you know there is no generic form of Lipitor?” While this is true, the consumer group claims that other generic options work just as well for most people with high cholesterol and Lipitor will itself become generic once its patent expires in 2010. The spots, a push to increase brand loyalty before the cutoff, also came under fire for featuring Dr. Robert Jarvik, who invented the Jarvik artificial heart in 1982 but does not practice medicine.

“It’s like a race car driver endorsing a plane,” said Russo of Jarvik’s role as Lipitor’s spokesperson. Media scrutiny of Jarvik, a Congressional investigation into the ad and disclosure that a body double was used in a spot where Jarvik was portrayed as rowing led Pfizer to pull the ad last month.

But it had an effective run. In December 2007, the Consumer Reports National Research Center conducted a study with 978 viewers who had been advised by doctors to lower their cholesterol. After watching the ad, 65 percent believed the ad said that leading doctors favor Lipitor, nearly half of them felt more confident in the drug because of Jarvik’s endorsement, and 29 percent believed Dr. Jarvik to be a practicing physician. Even with the ad shelved, Lipitor remains the No. 1 cholesterol-lowering drug.

Yet a brand name connection to viewers does have larger, and some say, beneficial implications.

“An advertisement or an article in a journal can get people to the doctor in the first place,” said Frank Burroughs, president of the Abigail Alliance for Better Access to Developmental Drugs in Fredericksburg, Va. “Knowledge is important, whether it be about approved drugs or off-label drugs.”

Burroughs, 61, believes most advertisements fairly address potential risks and side effects, but he added: “I rely on physicians. My doctor prescribed Lipitor for me; the commercial only reassured me. It’s important to understand that any prescription drug has to be approved by a doctor.”

Not surprisingly, the pharmaceutical industry also defends drug ads.

After the York University study on industry spending, Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, issued a statement refuting claims that pharmaceutical companies spend more on ads than on research and development of drugs, and highlighting the benefits of DTC ads.

The statement said that surveys show that direct-to-consumer advertising “helps start important doctor-patient conversations about conditions that might otherwise go undiagnosed or untreated.” Johnson also cited a survey by Prevention magazine showing that 29 million patients said that they discussed a health condition with their doctor for the first time after seeing a DTC advertisement.

Still, for practicing physicians, some of whom are compelled to prescribe drugs their patients have seen advertised on television, DTC ads can interfere with patient care.

“All things considered, it probably puts a strain in the doctor-patient relationship,” said Dr. Evans, who strives to be an “unbranded doctor” and runs a shop free of brand-named drug samples. “Ads are slick, make sense on the surface and depending on the relationship I have with my patients, if I say no, they may leave unhappy.

“In an ideal world, physicians would stay up to date using objective sources and would treat patients accordingly,” Evans continued. “Patients would come to doctors relying on them to be up-to-date. There wouldn’t be all these TV ads. I would not have to worry about watching a sports game and having my 8-year-old son asking what Viagra is.”

E-mail: cl2612@columbia.edu