If you are one one of those geezers like me who still watches the network nightly news and then stays tuned for Jeopardy, you know about the proliferation of drug advertisements that dominate these shows. Ads for erectile dysfunction, benign prostate hyperplasia (together and separately), constipation, inflammatory bowel disease (rarely together, mostly separately), arthritis, fibromyalgia, type 2 diabetes — the list goes on — have become the advertising base for these programs. They are aimed at an audience demographic of people who pay attention to what’s out there for chronic medical conditions facing many of us. (Let me just stop right here to say that getting old is not for sissies.)
The question now is whether the $4.5 to $5 billion a year spent to promote these products is a good thing, given how expensive pharmaceuticals — even generics — for many chronic conditions have become? It’s also worth asking, how are they impacting consumer spending and could the these promotions for certain drugs cause more harm than good?
The American Medical Association meeting in Atlanta yesterday thinks they may not be worth it. It is considering asking for a ban on such ads.
I’ve been following direct-to-consumer (DTC) drug advertising for years, since commercials for prescriptions in the highly competitive lipid-lowering (cholesterol control) market started showing up in the 1990s. The same misgivings about the wisdom of these ads now were voiced then: Will they push patients to demand their physicians write scripts for drugs that won’t work, or could be harmful? Are they even necessary? Many doctors at the time said it’s their job to keep up with the latest treatment protocols and they routinely stay up to date on how new drugs on the market perform and whether they might be good for their patients.
The drug manufacturers countered that the ads serve a very useful purpose in making consumers aware of the conditions they treat. From a broader perspective, the ads could actually help people suffering from depression, anxiety and other rarely-discussed conditions seek treatment, the manufacturers said, noting that all of their voice-overs include “talk with your doctor” language.
This line of thinking prevailed and, for the most part, the government’s regulatory apparatus allowed them to proceed. (Aside from the litany of potential side effects the manufacturers are required to note in each commercial for their product.)
Then Viagra hit the market and direct-to-consumer advertising exploded. Indeed, after those ads started appearing, as well as ads for competitors Cialis and Levitra (whatever happened to the Levitra ads?) middle-aged men flocked to their physicians to ask for the magic pills. The ads did a little more than raise awareness, if you know what I mean. They clearly drove demand for the product.
More recently, I have been intrigued by DTC advertising for two classes of drugs that, at least to me anyway, seem to have a much more limited market. You may have seen them as well and wondered the same thing.
One is for a condition called opioid induced constipation. (Lovely topic, thanks Mike for raising it.) If you have ever taken Percocet or hydrocodone after surgery to control pain, you may have learned that constipation is a side effect to those potent meds. But that’s usually a temporary condition, isn’t it? Once off the drugs, your body seems to return to normal function. Even while on them there are plenty of over-the-counter remedies that could be employed.
Is there really a need for a prescription-strength medication to deal with this issue? I suppose so if you must take these powerful meds over a longer period of time, but long term use of opioids poses much more serious risks (addiction, being the most obvious). Will marketing a drug to deal with this one side effect drive pain-management patients to physicians asking for more Percocet? I honestly don’t know the answer. Maybe it’s not a major issue. But then again, do we really need a television advertisement to suggest pain management patients discuss this with their doctors? Wouldn’t any doctor who prescribes opioids be discussing the risks of the drugs, including constipation?
The other newly advertised drug I have seen recently is for late-stage lung cancer. This one is intriguing for lots of reasons, not the least of which would be the small market of patients it seems to be targeted to — a patient market that by definition should be intensely monitored by cancer specialists and other experts. The new drug is being pushed as a medication that “could extend your life,” meaning that it isn’t a potential cure for the disease but might give you a few more months to live when you are in the end stages of the disease.
There are dozens of clinical trials for these important drugs that may one day be routinely prescribed for end-stage cancer patients. Some of them have very encouraging initial results. But so far, most of them provide a life-extending measurement of months, not years. (In the fine print in the commercial for this one drug you’ll see that this is disclosed. But you might miss it against the backdrop of images of healthy-looking people enjoying life with their grandkids and pets.) And, we have to note here as well, they are very expensive and not always covered by insurance the way conventional chemotherapy is.
My concern is this: End stage cancer patients are a particularly vulnerable group. So are their families. They see an ad like this and will be at their physicians door the next day wanting that drug. I suppose if the physician has neglected to discuss all the treatment alternatives available and the risks and benefits and costs of each, that’s not a bad thing. But will that very effective advertisement drive the decision more than physician judgment?
I honestly don’t know the answer. At a time when drug costs are driving up the overall price of health care in this country, the subject of direct-to-consumer advertising bears more examination.