DTC Drug Ads Prompt ‘Too Much’ Consumer Spending, Christian Science Monitor Says

In the four years since the FDA allowed pharmaceutical companies to air direct-to-consumer ads on television, "upbeat" commercials for "supposed wonder drug[s]" ending with a "list of daunting risks" have "flooded the airwaves and transformed the American medical landscape," the Christian Science Monitor reports. According to the drug industry, the ads help to "educate and empower a public hungry for medical information," which helps to improve the nation's overall health. Critics, however, maintain that the ads "change the balance" in the doctor-patient relationship, "create an unrealistic expectation there's a cure-all in a pill" and fuel "skyrocketing" drug prices by prompting consumers to purchase "vastly more expensive drugs than doctors say they need." Amid the "controversy," the FDA has begun to review the agency's guidelines on direct-to-consumer advertising to "determine the true nature of the impact."

'Floodgates' Opened
In 1997, facing "increasing pressure" from the pharmaceutical industry and television networks, the FDA allowed drug companies to air commercials "if they included 'information about any major risks'" and "where to obtain 'more detailed information.'" The Monitor reports that the decision "opened the floodgates." While drug companies had spent $51 million on advertising in 1991, by 2000 they had poured $2.3 billion into advertising. Sales of the "most heavily promoted," and often more expensive, drugs increased 30% to 50%, which experts maintain has helped "fuel spiraling" health care costs. In addition, the American Medical Association warns that drug ads offer only "snippets of information," rather than "more substantive data" that patients "might need to make a truly informed decision" about a treatment. "It can create an adversarial relationship between the doctor and the patient, because the patient wants this greatest, newest and best thing they saw on TV, and the doctor may not think it's necessary," former AMA President Dr. Thomas Reardon said. Critics also maintain that managed care has "squeezed" doctors' time with patients and "made it more difficult to have in-depth conversations on drug choices," leaving many physicians "feel[ing] pressured" to prescribe new drugs (Marks, Christian Science Monitor, 4/11).

What About the Placebo Effect?
Meanwhile, Holman Jenkins writes in a Wall Street Journal opinion piece that four years after the "wedding night might seem soon enough for the chaperon to get a life," but the FDA "continues to wallow in remorse" over the 1997 decision to allow the drug and advertising industries to "have their rakish way with each other." Amid criticism, the agency has "once again bustled into their boudoir," announcing a new review of the policy allowing the ads. Jenkins adds, "There is a growing element of mission creep here." He maintains that the FDA's "stated aim" -- to determine whether the ads "confuse consumers and adversely impact the relationship between patients and their health care providers" -- represents a "code" for the concerns of the insurance industry, which "doesn't like paying for advertised drugs." However, Jenkins adds, the FDA will not address the role that drug advertising plays in "promoting the actual efficacy of drugs themselves," known as the placebo effect -- the "loony aunt the pharmaceutical-industrial complex prefers to keep locked in a barn." Saying the FDA is "slowly losing its collective mind" and sending out hundreds of letters to "nitpick ad copy," Jenkins maintains that "maybe it's time the agency bluenoses took an intelligent interest in the placebo effect" to determine "how much the pharmaceutical industry is simply selling back to us our own faith in its products," rather than "cruising Madison Avenue looking for busts." He concludes, "If the FDA wants to convert its prurience into something useful, it would seek to have such studies continued in hopes of explaining the high placebo response. This could only lead to better medicine" (Jenkins, Wall Street Journal, 4/11).