Should Direct-to-Consumer Advertising Be Turned Off?

Direct-to-Consumer advertising
Only the US and New Zealand allow drugs to be advertised directly to consumers. Should we join the rest of the world in banning ads? Read more >>

If you’re an American who spends even a tiny amount of time watching TV, you can’t have missed the explosion of advertisements for prescription drugs. You know the ones: “Ask your doctor if whatever-the-drug-is-called is right for you!” The average TV viewer can expect to spend as many as 16 hours per year watching pharmaceutical ads ranging from rheumatoid arthritis to erectile dysfunction — and that doesn’t include print ads cluttering magazines or splashed on billboards.

But are these commercials (which feature actors who look suspiciously healthy!) a good thing for the average consumer?

The American Medical Association (AMA) doesn’t think so. The group recently called for a ban on the ads, which are called DTCA or Direct-to-Consumer Advertising, saying that one troubling effect is higher drug prices for consumers.

The membership’s vote in 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 fueling escalating drug prices,” AMA Board Chair-Elect Patrice A. Harris, MD, said in a news release. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”

A report by the AMA Council on Medical Service supports the claim that drug ads spur higher prices: “Prescription drug spending was estimated to have increased by 12.6 percent in 2014, the highest rate of growth in the sector since 2002.”

On the other hand, there’s an argument to be made that DTCAs give consumers good information about the risks and benefits of a drug, especially when a drug is newly approved and may offer a novel and possibly more effective treatment option. This question — if it’s good or bad for consumers’ choices — is what concerns the FDA.

FDA’s Bad Ad Program

The US and New Zealand are the only 2 developed countries with direct-to-consumer advertisements. In this country, the FDA oversees prescription drug advertising with the Federal Food, Drug, and Cosmetic Act and related regulations. Through the DDMAC (Division of Drug Marketing, Advertising, and Communications), the FDA ensures that all prescription drug promotions provided by drug firms are truthful, balanced and accurately communicated.

But are the ads always honest?

DDMAC requires drug companies to include all of a drug’s risk information when they make product claims. In print ads, this is usually in a fine-print section called the “Brief Summary.” Obviously advertisers can’t put all that onto a TV screen, so broadcast ads are allowed to include only the most important risk information — as long as the ads tell viewers or listeners how to get the full FDA-approved prescribing information, which describes all of the drug’s risks.

DTCA can be misleading by either omitting risk, or overstating effectiveness. For example, saying that “Drug X delivers rapid results in as little as 3 days” is misleading because the majority of patients studied in the clinical trials for Drug X showed results at 12 weeks, with only very few showing results in 3 days.

Then there are the really direct ads, such as social media posts that make it appear as though a celebrity is, of her own accord, endorsing a drug. One recent example: reality-TV star and social media darling Kim Kardashian touting the morning-sickness drug Dicelgis on her Twitter feed. It turns out that Dicelgis’ manufacturer, Duchesnay USA, paid the star a reported $1 million for the post (a bargain considering Kardashian’s massive social media following). The FDA condemned the practice, but the fact is that rules surrounding social-media promotion are still hazy. (It’s impossible to present risks in 140 Twitter characters, after all.)

What Do Doctors Think?

The ads say to “ask your doctor…”, but what does the average doctor think about DCT ads? An FDA survey of physicians released in November 2004 helped the agency better understand benefits and risks of DTC ads. The survey uncovered the following drawbacks:

  • Physicians thought the ads did not convey information about risks and benefits equally well. 78% of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40% who believe their patients understand the possible risks, and 65% believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. In addition, about 75% of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does.
  • Many physicians felt pressure to prescribe something when patients mentioned DTC ads.

However, DTC ads allow a consumer to learn about a prescription drug so they have a more informed basis to decide with their physicians whether to use it. The survey of physicians also found that:

  • If their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.
  • Many physicians thought that DTC ads made their patients more involved in their health care.
  • DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments.
  • Doctors believe that patients understand that they need to consult a healthcare professional about appropriate treatment. 82% responded either “very well” or “somewhat” when asked whether they believe that their patients understand that only a doctor can decide whether a drug is right for them.

A recent editorial that ran in both the Chicago Tribune and the Orlando Sentinel defended these ads: “Consumers get the benefit of learning about potential treatments. Then, as the ads say, they can discuss the options with their doctors. That’s when issues such as cost and alternate treatments can be considered. Drug makers also say the ads can lessen the stigma associated with some conditions.”

What Can You Do?

The FDA has a consumer site for reporting ad violations: Be Smart About Prescription Drug Advertising, A Guide for Consumers, which is designed to educate consumers about how to view DTC advertising, prepare them for discussions with healthcare professionals, and help improve patient understanding and medical care.

Finally, remember to talk with a physician and a pharmacist about risks and benefits of prescription drugs, especially in the context of your personal health situation.

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