The Big Pill Pitch
Drug companies are marketing directly to patients. Is this empowering or perilous?
When patients come into Lloyd VanWinkle's family practice clinic in Castorville, Texas, they often know exactly what they want. That's because more and more often, after seeing drugs advertised on television or in print, his patients describe symptoms they think might be treated by medication. Sometimes his patients just ask in general terms about possible drug treatments. But more and more, VanWinkle says, their requests are highly specific: "I want the acne birth control pill." Either way, this new patient activism is motivated by aggressive drug company marketing.
Pharmaceutical companies spent more than $4 billion in 2004 on direct-to-consumer advertising, a 23 percent increase over the previous year, according to IMS Health. Since 1997, when the Food and Drug Administration changed guidelines on prescription drug advertising, opening the door to television ads, the industry has been increasingly bypassing the physician and pitching more and more drugs directly to the public. Today, it's hard to make it through a prime-time TV show without seeing a drug commercial.
The United States and New Zealand are the only countries that allow pharmaceutical companies to pitch directly to consumers, and here there's controversy over the ads' effects on public health. "What we're finding is that it's not bad or good" for public health, says Richard Kravitz, a doctor at the UC- Davis School of Medicine who has done numerous studies on the effects of direct-to-consumer drug marketing. One, published last month in the Journal of the American Medical Association , suggests that patients who ask for an antidepressant pill are more likely to be prescribed that pill--whether their symptoms warrant it or not. Critics have long focused on the potential for overtreatment, while proponents of advertising have argued it empowers consumers by making them aware of medication that could help them. Now, with companies spending billions, new studies are showing just how influential those ads can be for both doctors and patients. Critics, including some in Congress, are calling for tougher standards and guidelines on drug advertising.
Surprisingly, some inside industry are beginning to agree. "We can do a lot better," says Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America, the industry's top lobbying organization. PhRMA plans to release voluntary guidelines for industry later this year that will specify goals for the ads. For example, they say the ads should make the risks and benefits clear and should be directed toward people with the condition. A similar effort several years ago fizzled, though now, says Tauzin, there's more of a general feeling among board members and drug industry executives that these voluntary guidelines are a "must do."
Cooling off. Critics of PhRMA's guidelines say that by coming up with their own standards the industry is trying to pre-empt possibly stricter changes from the government. Letting the pharmaceutical industry regulate its own advertising is like "the fox guarding the chicken coop," says Democrat Henry Waxman of California. Instead, he says that the Food and Drug Administration needs to get tougher. A report released by Waxman's office last year argued that lax enforcement of existing laws by the FDA allowed "false and misleading" advertisements to keep running for six months or more before they were pulled.
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