The Politics of Women's Health
Direct to Consumer Advertising
Misleading Ads and How They Hurt Us
By Judy Norsigian. Previously published as a commentary on the Women's Media Center website on 5/22/07.
Selling anxiety sells medicine. Drug companies know this and profit by it. But are women benefiting as much as the industry’s bottom line?
The pharmaceutical industry spent much of its $4.2 billion direct-to-consumer advertising budget in 2005 on ads targeting healthy upper-income, middle-aged people. A common underlying message was this: you appear to be healthy, but a deadly heart attack, hip fracture, or other medical catastrophe could occur at any time. Therefore, you should take a prescription drug to prevent such problems.
For example, a long-running Merck ad featured an older woman with this message: “See how beautiful 60 can look? See how invisible osteoporosis can be?” and recommended that women ask their doctors about bone density screening. As a result, many women started taking Merck’s drug Fosamax, even though the benefit may not outweigh the harm.
With such direct-to-consumer ad campaigns, which highlight risk factors and promote screening tests, drug companies move beyond promoting certain pills for treatment of diagnosed conditions to expanding their use in healthy people. And selling prevention through prescription drugs certainly does fill pharmaceutical industry coffers. Healthy people, preferably in early middle age, who can be persuaded to take a drug daily for the rest of their lives, are clearly the industry’s most desirable customer base. But as a category, these people who are at low risk of having the problem the drug is meant to treat may still suffer a serious adverse reaction. For example, Fosamax cuts the risk of hip fracture from 2% to 1%, but that small benefit may not be worth the 1.5% risk of suffering an esophageal ulcer. In addition, in a small percentage of women using Fosamax over the long term, the jawbone will start to crumble. And some research now suggests that the type of new bone created by Fosamax is more brittle and more prone to fracturing over time.
The over-selling of postmenopausal hormones, supported by the depiction of natural menopause as a hormone deficiency disease, was the forerunner to this type of sales pitch, which now permeates the media. Aging, social anxiety disorder, heartburn, restless leg syndrome, and overactive bladder are all examples of symptoms or normal physiological events that are now presented to consumers as being in need of long-term drug treatment.
Prescription drugs used to be advertised mainly in medical journals aimed at health care providers. But since 1997, when the Food and Drug Administration (FDA) loosened the restrictions on direct-to-consumer advertising, pharmaceutical companies have taken their messages directly to the people. They claim these ads are good for consumers because they educate and encourage individuals to be more involved in their medical choices. But whatever the industry’s philanthropic motives, the more direct interest is the bottom line. As Marcia Angell, a former editor of the New England Journal of Medicine, once put it, “They are no more in the business of educating the public than a beer company is in the business of educating people about alcoholism.”
Because of direct-to-consumer advertising, more people request prescription drugs from their doctors, and most doctors comply. Most lay people—and even many physicians—are not aware that drug ads are not checked by the FDA for accuracy beforehand, and are pulled only after complaints are made and verified. This usually takes about six months, and the drug company is given a grace period of several additional months, by which time most ads would have been changed anyway. A company is rarely required to run a corrective ad, and there is no other penalty for misleading the public. Thus, while the FDA sends hundreds of letters each year requiring drug companies to retract their ads, most people don’t hear about them.
Women need to recognize misleading pharmaceutical marketing practices and base drug treatment decisions on scientifically accurate evidence. Be most skeptical of heavily advertised drugs and those that come with coupons. They are the newest, most expensive drugs with the shortest track records of safety. The FDA does not require new drugs to be proven better than competing, often cheaper, drugs already on the market. Though many drugs for chronic conditions like arthritis are taken every day for years, pre-approval trials typically last no more than a few months and long-term safety studies are almost never done. Life-threatening effects may come to light only after the drug is approved and used widely.
To reduce unnecessary risk, women should seek independent sources of evidence about medicines, particularly new ones. The FDA's web site offers extensive information about medicines, herbal supplements, and vitamins, including safety alerts about the latest recalls and warnings for specific drugs. The international nonprofit group Healthy Skepticism counters misleading drug promotion and maintains a regular “AdWatch” section on its website. Consumers should be cautious when looking for information on other websites. Many are substantially sponsored by pharmaceutical companies. Being skeptical about drug ads and promotions is smart: it can protect both our health and our wallets.
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