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Push Comes to Shove

Do advertisements for prescription medications educate consumers—or encourage them to take drugs they don’t need?

By Michael Hirson // Fall 2005
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Do advertisements for prescription medications educate consumers—or encourage them to take drugs they don’t need? Since 1997, when the Food and Drug Administration relaxed restrictions on direct-to-consumer advertising of prescription medicines, that debate has pitted drugmakers against regulators, consumer groups and many physicians. Now the pharmaceutical industry has made a concession.

In August the Pharmaceutical Research and Manufacturers of America (PhRMA) announced a set of voluntary guiding principles, calling for companies to submit ads to the FDA before they air, to clearly explain risks and benefits, and to spend an “appropriate amount of time” educating physicians prior to advertising new medications. A PhRMA office of accountability will monitor compliance and make reports available to the public.

Each year as many as a third of consumers ask doctors about drugs they’ve seen advertised, and some 40% of these discussions lead to prescriptions. Pharmaceutical companies cite the benefits of advertising, including studies showing increased awareness of treatments for such conditions as depression. But nearly 80% of doctors believe advertising inclines patients to ask for medications they don’t need—requests physicians admit they sometimes oblige.

“Best case, a doctor will explain why an existing drug may be more appropriate,” says Robert Centor, a professor of internal medicine at the University of Alabama. “But physicians sometimes take the path of least resistance and prescribe what the patient wants.” To discourage that, Centor favors counter-detailing, in which managed-care groups respond to drug-company promotions by listing for physicians which drugs have proven safest and most cost effective.

Not likely to be on that list are drugs in a heavily advertised class known as COX-2 inhibitors, including Merck’s Vioxx. Responding to studies showing cardiovascular problems associated with such drugs, Senate Majority Leader Bill Frist, a physician, has proposed requiring drug companies to wait two years before advertising newly approved drugs. Bristol Myers-Squibb has already instituted a voluntary 12-month waiting period. “If you educate physicians about risks and benefits before you advertise to consumers, physicians can have an informed discussion with patients,” says a spokesperson for Bristol Myers-Squibb.

In July the American Medical Association said it would begin studying the effects of drug advertising. But in the meantime, the U.S. remains the only industrialized country (other than New Zealand, and even that nation is on the verge of a ban) that allows direct-to-consumer drug advertising. “We’re essentially conducting a vast, uncontrolled experiment on the public,” says Matthew Hollon, an assistant professor of medicine at the University of Washington and one of the leading experts on direct-to-consumer advertising.

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