One night in 1997, as Americans were parked on the couch in front of an episode of Touched by an Angel, they were touched by something else unexpected: an ad for a prescription allergy pill called Claritin, promoted directly to the consumer! Prescription drugs had never been sold directly to the public before, because, without a doctor’s recommendation, how could people know if the medication was appropriate or safe?
These are the “Ask Your Doctor” ads.
Ask Your Doctor
Soon, ads for Xenical, Meridia, Propecia, Paxil, Prozac, Vioxx, Viagra, Singulair, Nasonex, Allegra, Flonase, Pravachol, Zyrtec, Zocor, Flovent, and Lipitor followed. By 2006, the pharmaceutical industry (a.k.a. Pharma) was spending $5.5 billion a year on direct-to-consumer (DTC) advertising – as much as the US government was spending for an entire month on the Iraq War!
Although DTC advertising was never illegal, according to the Food and Drug Administration (FDA), it was widely thought to be until the FDA issued guidelines for advertisers in 1997.
And then a funny thing happened as Americans viewed all these pill ads: People discovered they weren’t as healthy as they had thought.
“Sufferers” Surface in Step With Drug Ads
Suddenly, people “suffered” from seasonal allergies, social anxiety, high cholesterol, depression, bipolar disorder, ADHD, erectile dysfunction, low testosterone, gastroesophageal reflux disease (GERD), irritable bowel syndrome, dry eye, fibromyalgia, chronic fatigue syndrome, seasonal affective disorder (SAD), restless legs syndrome, and worse. In fact, the parade of symptoms and diseases was so all encompassing, comedian Chris Rock said he was ready for a DTC ad asking, “Do you fall asleep at night and wake up in the morning? You might be suffering from … .”
For example, before the advent of DTC advertising, gastroesophageal reflux disease, or GERD, was a hidden “epidemic” and in many cases was really just heartburn and poor eating. But, after the drug’s marketing campaign succeeded in making people realize they suffered from the problem, GERD ads vaulted Nexium to be the fourth-best-selling drug in the country!
Web Helped DTC Ads and Vice Versa
The fact that DTC advertising debuted at the same time as the World Wide Web doubled its power. Even if ads and websites weren’t advertising drugs directly to consumers, the world of diseases and prescription drugs, once tucked into JAMA ads, was suddenly open to anyone who could operate a mouse. You could even buy drugs online, no doctor or prescription necessary.
Theoretically, all the newly and readily available medical information created a better-informed patient; patients certainly should have the right to know and be participants in their own healthcare. But three features of DTC advertising did more harm than good-unless you were Pharma.
Diseases were created or overplayed, sometimes called “disease du jour.”
Risks of disease – fears of getting a condition or the condition getting worse – were whipped up to sell drugs.
Extreme, injectable drugs were marketed when milder and cheaper drugs would do.
The advent of DTC advertising and online “symptom checkers” and “health quizzes” also led to self-diagnosis and a “sickness culture” – sometimes called “cyberchondria.” It reduced doctors to gate keepers and order takers as Pharma became an over-arching, primary US advertiser.
Expensive, Injectable Drugs Began To Dominate
As DTC advertising took hold, costly, genetically engineered, injected drugs like Prolia, Humira, Enbrel and Remicade (called biologics) were aggressively marketed as first, rather than last, choices in autoimmune conditions despite their dangerous side effects. For example, in 2008, the FDA announced that forty-five people died from fungal diseases from taking such drugs – 20 percent of the 240 patients who got sick – yet the drugs remained and continue to remain best sellers.
Humira was especially problematic. In 2008, it was investigated by the FDA for thirty reports of childhood cancer and its links to lymphoma, leukemia, and melanoma in children. In 2011, the FDA warned that Humira can cause “a rare cancer of white blood cells” in young people. The same year, five patients died during Humira trials in Italy, and the entire drug class was found to be linked to heart risks.
DTC Ads Are A Hit With Everyone … Almost
Almost everyone liked DTC advertising when it began and they still do: Pharma likes it because it sells drugs without sales reps, medical centers like it because it brings in more business, news outlets and TV shows particularly like it because it can represent the majority of their ad revenues and the public likes it because ads are entertaining.
But DTC ads also “sell” diseases, making people think they are sick, sell drugs that are more expensive and less proven safe than older drugs and, fundamentally, increase everyone’s health care costs. So, from a public health standpoint, DTC ads are not “healthy” at all.
Now that “Ask Your Doctor” ads are everywhere, we know they aren’t good for people or their doctors. They are good for Big Pharma and the media that get paid to display them. And they fill up medicine cabinets all over the country.