Sunday, June 20, 2010

Are Direct-to-Consumer Drug Ads Right for You?

Should the public be shielded from medical information that can mislead it? Many argue against direct-to-consumer (DTC) advertising, which is omnipresent in print and on the airwaves. Opponents of this practice argue that it promotes the use of expensive medications when patients ask their doctors if the ‘drug is right for them’, the tag line that appears at the end of every ad. This phrase is the drug company’s limp disclaimer that it is really the physician who will make the prescribing recommendation. Yeah, right. Of course, DTC ads promote drug sales. Isn’t that the purpose of advertising? Antagonists of this drug pushing state that resources spent on advertising should be used instead to lower drug prices for consumers. Couldn’t the same argument be made about any product being advertised? Should General Motors cease and desist from spending marketing money and divert these funds instead for consumer rebates? Legal products have the right to advertise and market their wares.

Personally, I dislike the tsunami of drug ads that are in my face several times daily. I don’t agree that they provide useful health information, despite claims that they are public service announcements. They annoy me. Nevertheless, the pharmaceutical companies, like any business, have a right to advertise and promote their products, and I would oppose an effort to ban the practice. I think that the industry’s commercial right to free speech trumps arguments advanced to restrict this practice. The twist here in the pharmaceutical business is that the public cannot directly purchase their products, as it can with cars, breakfast cereal and house furniture.

I would support a targeted advertising ban, particularly on television, for various urologic potions that promise to bring new blood to an old pastime. I cannot count how many times over the years these ads have popped up while my kids were watching television. While the industry claims that these ads are not run during family viewing hours, this time slot definition never seems to apply to my family. I would support restrictions on these ads during appropriate hours on the basis of public policy, as the companies do have a potent free speech argument. Of course, companies could enact a voluntary moratorium, which would generate good will at the expense of brand exposure and sales. I don't expect this as when business interests collide with family values, guess who wins?

Why should my kids and yours have to be acquainted with Viagra, Cialis and Levitra, and learn words and phrases that are not yet essential in their lexicons? Of course, the companies could counter that if I am concerned about the content of their ads, that I should disable the cable. Similarly, Howard Stern retorted to critics of his radio show that if they were offended, then they should change the station. He further stated that he wouldn’t permit his young children to listen to his show as he believed that the correct response to adult content was proper parenting, and not censorship. He has a point, but even good parents cannot hover over our kids every moment.

Of course, its not just drug companies that are pursuing DTC ads with gusto. Physicians and hospitals are hawking our goods and services with zeal and enthusiasm as we troll the countryside for patients. Here in Cleveland, these ads are a ubiquitious plague upon us. These ads can pose curious conflicts. For example, how many hospitals can fairly claim to be #1 in cardiac care?

Hospital marketing mavins don’t just push individual doctors or traditional medical specialties on us. They now lure us to ‘women’s health seminars’, ‘spine centers’, ‘digestive institutes, ‘sports medicine departments’ and ‘wellness centers’. Many conventional medical institutions are now offering alternative medical services, knowing that this is a marketing magnet for a believing public. Should the choice of a specific medical service by a health institution be a medical or a marketing decision?

I don’t like all of this advertising clutter and static, but I can’t avoid it, and we can’t change it. Medicine is now as much of a business as it is a profession. With all the changes that I fear await the medical profession, I wonder how college students will respond to the question,’ is medicine the right profession for you?’


  1. This is a great post. All of the competing cacaphony in medical advertising and other health care "info" has moved beyond the point of usefulness, for me anyway. I liken it to a recent trip to the grocery store and standing in the aisle looking for a bottle of olive oil. There were dozens to choose from: all slightly different. I'm sure there are good uses for all of them, but I wondered aloud to my companion why the heck we needed so many!

    I find the healthcare stuff just as much meaningless noise anymore, and I am just as apt to make my medical decisions the same way I made my grocery decision: screw this, I'll find some other way.

    I wonder how many others are like me, overwhelmed by the medical/healthcare cacaphony, and just walking away in disgust, and hoping for the best.

  2. I am only a medical student, so I may be naive in my thinking, but just because a patient comes in asking for the latest prescription drug they have seen on TV does not mean that the physician is obligated to prescribe that medication. I have already seen way too many physicians that will prescribe almost any drug at the patient's request--it disgusts me.

    That being said, I do believe that DTC drug advertisements are ridiculous. With the years and years of training physicians receive, patients ought to trust the physician's decision to prescribe a specific medication. What's next? Are imaging companies going to start advertising that you should get a T2 weighted MRI instead of a T1 weighted image? We almost have that here in Houston--there are big billboards on major highways stating that PET scans are better at detecting cancer. Hell, why even bother having physicians, people should just use WebMD and then order their own meds online! HAH

    In an ideal world, the pharmaceutical companies should present their research on their products to physicians who should then discuss available options with their patients. Perhaps this is ancient history (that is if it ever truly existed)?

  3. Mark, thanks for commenting. There are two flaws in your comment. First, there is no 'only', as in "I am only a medical student". Secondly, I do not think you are naive.

  4. Michael:
    I am (only) a pain specialist with all of the board certifations to satisfy... I LOVE DTC ads! Why? When a patient asks for a specific product, it is 90% more likely to help their depression/pain/neuropathy/etc. than what I would have given them (a little evidence-based thing called the "placebo effect"). If ONLY I could get the drug approved by their insurance without my medical assistant spending 3 hours on the phone... just a thought :).

  5. Interesting comment above re placebo effect. And I thought that DTC were 'only' ads. Wrong again!

  6. Michael,
    I like this post a lot, in part because I share your ambivalence about the ads. They're annoying and misleading. But censorship is problematic, as you point out.

    What I'm wondering is how much better physicians are at discerning hype from valuable information, as compared to people who aren't doctors. I suppose that overall, we're a better-educated group but, just like everyone else, we're suckers for attractive graphs and hope.

  7. Elaine, I don't think that we physicians are a tough sell. There's a reason drug companies spend so many millions of dollars sending folks to our offices. They do it because it works. It would be interesting to study and understand why we prescribe particular drugs. I suspect it is a complex process. Perhaps, the pharmaceutical folks have done some of this (unpublished) work. Thanks for commenting.