Direct-to-Consumer Advertising under Fire: Pharmaceutical Companies That Market Medicines Directly to Consumers in the United States of America (USA) Are under Increasing Pressure to Rein in Their Inventive Urges, While Attempts to Establish a Bridgehead in Europe Look Doomed to Failure

By Humphreys, Gary | Bulletin of the World Health Organization, August 2009 | Go to article overview

Direct-to-Consumer Advertising under Fire: Pharmaceutical Companies That Market Medicines Directly to Consumers in the United States of America (USA) Are under Increasing Pressure to Rein in Their Inventive Urges, While Attempts to Establish a Bridgehead in Europe Look Doomed to Failure


Humphreys, Gary, Bulletin of the World Health Organization


The distinguished doctor who has been introduced as the "inventor of the artificial heart" turns to the camera and says, "Just because I'm a doctor doesn't mean I don't worry about my cholesterol." He then recommends people use an anti-cholesterol drug, Lipitor, and to show just how confident he is in his own ticker, he rows across a lake. It was a killer advertisement, part of a campaign put together at a cost of US$ 260 million for drug company Pfizer. But it relied on the audience being unaware of several important facts: Robert Jarvik, the distinguished "doctor" in the boat, had never been licensed as a medical doctor, could not legally prescribe anything and was not the inventor of the artificial heart (at least according to three former colleagues at the University of Utah). It later turned out that he hadn't even rowed the boat. Welcome to the world of direct-to-consumer advertising.

Direct-to-consumer advertising of drugs has been legal in the USA since 1985, but only really took off in 1997 when the Food and Drug Administration (FDA) eased up on a rule obliging companies to offer a detailed list of side-effects in their infomercials (long format television commercials). Since then the industry has poured money into this form of promotion, spending just under US$5 billion last year alone. The only other country in the world that allows direct-to-consumer drug ads is New Zealand, a country of just over four million people.

Direct-to-consumer advertising informs patients potentially suffering from disease and raises their awareness of treatment options, according to Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade group. But critics of the practice, and there are many, have their doubts. "The truth is direct-to-consumer advertising is used to drive choice rather than inform it," says Dr Dee Mangin, associate professor at the Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand, pointing out that the 'driving' is typically in the direction of expensive brand-name drugs. New Zealand consumers then go to their doctors and the pressure to prescribe begins. Surveys carried out in New Zealand and in the USA show that when a patient asks for a specific drug by name they receive it more often than not. "In an era of shared decision-making, it's much more likely that general practitioners will just do what the patient asks," says Mangin. It goes beyond that, of course, because doctors are also being enticed by pharmaceutical companies to prescribe their drugs.

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The net result is higher cost for the consumer or tax payer. It is the issue of costs that has put the issue of drug marketing and consumption firmly at the heart of the Obama administration's current review of the USA's health-care system. "Some of the more thoughtful people in the USA recognize that part of the reason they have a drug expenditure bill that is completely out of control is this kind of advertising," says Suzanne Hill, a scientist working on rational drug use and drug access at the World Health Organization (WHO). Not so, says PhRMA'S Johnson in a statement in May this year: "[direct-to-consumer advertising] benefits the entire healthcare system in the USA by encouraging patients to seek medical attention that may help them manage their conditions and avoid unneeded hospital stays or surgeries," he says, arguing that fewer surgical interventions inevitably reduce costs. …

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Direct-to-Consumer Advertising under Fire: Pharmaceutical Companies That Market Medicines Directly to Consumers in the United States of America (USA) Are under Increasing Pressure to Rein in Their Inventive Urges, While Attempts to Establish a Bridgehead in Europe Look Doomed to Failure
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