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.
The movement toward change is also driven by the cooling of consumers toward ads. In 1999, more than half of respondents to an FDA survey said they like seeing drug ads. In 2002, the number was less than a third, and 60 percent of respondents felt ads didn't provide enough information about risks of a drug. "There's generally a recognition that we're making some people pretty mad by some of the direct-to-consumer advertising. And making your customers mad is not generally a good strategy," Pfizer Chairman and CEO Hank McKinnell said in a press conference last week.
Still, whether we like them or not, the ads seem to be working. Multiple surveys have shown that the huge majority of us are aware of brands that are advertised on television. Even if a much smaller percentage actually go to their doctor, request and receive that drug (surveys show that happens about 5 to 7 percent of the time) that still translates into millions more prescriptions per year.
The ads work because they make use of the best advertising psychology available. They show people with allergies romping happily outside or someone who's had chronic heartburn scarfing down pepperoni pizza. Such images are "incredibly powerful," says Matthew Hollon, an internal medicine physician at the University of Washington. They convince people that medication can help them enjoy life more.
Recent signs, however, suggest that drug companies may be questioning the wisdom of investing in TV ads. After the FDA requested last November that Pfizer pull ads for its popular erectile dysfunction medication Viagra (the one that showed a man with blue devil's horns), the company noticed only a small drop in sales. The 4 percent drop between October and March was pretty much the same decline one would expect from increased competition in the marketplace. So drug executives were left wondering if they really needed to invest so much in the small screen. Still, says Mark Bard, president of the marketing firm Manhattan Research, "TV remains king" for now, accounting for almost double the amount of money spent on all other media combined in 2004, according to IMS Health.
Patient power. Even direct-to-consumer ad critics credit the marketing for getting people into the doctor's office who might not have otherwise gone. Television, print, and Internet ads for Viagra persuaded millions of men to see their doctors. And, when men went in to get their little blue pills, thousands were diagnosed with other conditions such as heart disease or diabetes.
But doctors and critics worry that drug marketing leads patients to insist on specific drugs when other drugs or lifestyle changes might be better for them. In the past few years, says Cynthia Romero, a family practice physician in Virginia Beach, Va., "patients are more aggressive in trying to do things on their own. It's sometimes really difficult to try to sway them when they have in their minds, 'I saw that ad, and I need that pill.' " She says that the insistence on drugs is frustrating and that many patients want a "quick fix" instead of looking deeper about what may be causing their symptoms.
While patients taking charge of their health is generally good, Hollon says it can make doctors feel cornered when a patient insists on one medication. "Patients should appreciate that direct-to-consumer advertising makes them think about important health issues," says Hollon. But when you go into the doctor, don't expect that "the ad medication is the right medication."
This story appears in the June 6, 2005 print edition of U.S. News & World Report.