BY: DANIEL WATERBORNE
Why are pharmaceutical drugs even advertised to consumers who can’t actually buy them without spending an hour reading year-old magazines in a sterile waiting room? According to Lynn Payer, a prolific writer on the reciprocal influence of medicine and culture, drug advertisements are meant to “gnaw away at our self-confidence.”
The United States and New Zealand are the only two countries in the world that allow prescription drug advertising directly to consumers.
Disease mongering is the practice of pharmaceutical companies that uses aggressive media campaigns to “raise awareness” for a health condition that is sweeping, urgent and of course, treatable. It expands the definition of medical illness and in doing so expands the consumer market for patented treatments. But these advertisements not only have a profound effect on the year-end profits of pharmaceutical companies—the medicalization of routine aspects of life has an equally significant effect on human psychology.
According to EMBO Reports, a peer-reviewed scientific journal, the average American is exposed to ten drug advertisements per day on television or the Internet.
Last month, the American Medical Association, which represents 235,000 doctors, stated that pharmaceutical companies shouldn’t be able to advertise directly to consumers. Drug company advertising dollars have increased by 30 per cent in the last two years, and in 2014 alone drug companies spent $4.5 billion. For half a decade, prescription drug prices have been rising, experiencing a 4.7 per cent spike in 2015.
The AMA’s “support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fuelling escalating drug prices,” said AMA Board Chair-elect Patrice A. Harris, M.D., M.A. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”
Often direct-to-consumer drug advertising takes the form of “educational programmes” that disguise promotional marketing as news or scientific studies.
These awareness campaigns seek to maximize potential markets by framing ordinary experiences as symptoms of larger diseases, by using broad definitions for diagnosis and by exaggerating prevalence rates without disclosing study methodology. The concept is simple: establish a “need,” and provide a one-stop solution.
According to the National Centre for Biotechnology Information, a prime example of disease mongering is an advertisement for Strattera® developed by Eli Lilly & Co. A model was plastered across billboards with a facial expression of immense stress. The headline read“Distracted? Disorganized? Frustrated? Modern Life or Adult ADD?” It went on to say that Adult ADD usually goes undiagnosed because “symptoms can be mistaken for a stressful life.”
Similarily, Paxil® was marketed to treat social anxiety disorder. Symptoms include fear of public speaking and fear of using public bathrooms. According to drug-maker GlaxoSmithKline, shyness should be treated with an anti-depressant.
The first major problem with drug ads is that aggressive marketing strategies can frame nearly anything as a disease.
By nature, drug advertisements seek to increase demand, often by sensationalization to manufacture “needs”. It’s not personal. It’s just business.
The second major problem with direct-to-consumer drug advertisements is that they can often gloss over adverse reactions with language that targets emotions.
In an advertisement for Mirena®, an intrauterine birth control system, a paid representative says “How many of you feel so busy that you often can’t find time to take care of yourself? And do you think this impacts your level of intimacy?” The representative goes on to say “But what this party is really about is looking at the whole picture and figuring out steps to take to simplify your lifestyle while still looking and feeling great. One of those ways is finding a birth control that is compatible with your busy lifestyle.”
Claims such as “looking and feeling great” or that this method of contraception will increase levels of intimacy and romantic satisfaction are grounded in zero evidence. While focusing on an emotionally targeted language, the advertisement fails to get across the proven facts that using Mirena® can result in infertility, depressed mood and the greatest hidden contradiction— decreased libido.
Direct-to-consumer advertising is further complicated by the financial incentives that prescribers, like doctors and psychiatrists, receive from drug makers so that consumers can gain access to marketed products. This often comes in the form of research funding, paid speaking engagements, and funding for continuing medical education.
Anxiety and fear are powerful promotional tools. But with advertisements heightening demand for patented drugs is the urge to market, superseding drug-makers’ function to innovate?
“This is not a healthy way to run a society. It’s putting disease at the centre of human life,” writes award-winning health journalist Ray Moynihan.
According to Moynihan, direct-to-consumer advertisements have created a pill-for-every-ill culture. The problem is that even when the drugs come from a doctor, use of newer shinier prescriptions is much like walking a tightrope. Take Vioxx for example, an aspirin alternative that resulted in anywhere between 39,000 and 61,000 deaths in the United States.
Marketing drugs to consumers can help to foster an environment that permits abuse. Currently, Adderall is being used on college campuses much the way that performance enhancing drugs were used in cycling—students are faking symptoms to obtain a prescription or illegally obtaining pills to just compete.