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A cute, animated ball bounces around very sadly until he takes a magic potion; suddenly, it becomes happier than ever. No, that isn't the plot of a new children's movie. On the contrary, it's the storyline of a Zoloft commercial – yes, Zoloft, a powerful antidepressant drug. In the 1990s, direct-to-consumer advertising like this increased at a compounded-annually rate of 30 percent, according to Ian Morrison's book, Health Care in the New Millennium. In fact, by 1995, drug companies had tripled the amount of money they formerly allotted to consumer-directed advertising, writes to Gary Null in Death by Medicine. Since then, pharmaceutical advertising has grown to an entirely new, pop culture-savvy level.
These days, it's hard to tell the difference between pharmaceutical commercials and car commercials. Both are almost always intended to look "cool." Car and pharmaceutical commercials use the same hooks -- popular music, good acting and lofty promises -- to hook consumers and reel them in. Falling prey to car commercials results in little more than hefty car payments; however, becoming seduced by pharmaceutical companies can result in the consumer willingly taking powerful drugs, at the risk of serious illness and even death. In spite of this tremendous risk, pharmaceutical advertisements are becoming increasingly common and, unfortunately, increasingly effective.
In 2000, pharmaceutical companies spent $2.5 billion on mass media pharmaceutical advertisements, according to Mike Fillon in Ephedra: Fact or Fiction. This number increased to over $3 billion in 2003, according to Dr. John Abramson's book Overdosed America. In his book, Death by Prescription, Ray D. Strand looks at these high figures and poses the question: "Why?" Why do pharmaceutical companies spend billions of dollars on direct-to-consumer advertising, when consumers can only obtain prescriptions for these drugs through a doctor? Wouldn't it seem that consumers have no influence whatsoever on the success of a prescription drug, so advertising should be directed entirely toward doctors?
That makes sense, but it's not the way things work. Pharmaceutical companies wouldn't spend billions of dollars on direct-to-consumer advertising if it didn't work. In fact, the advertisements are working … too well. Fillon writes, "The average number of prescriptions per person in the United States increased from 7.3 in 1992 to 10.4 in 2000. Along with this increase in demand, there has been a shift towards the use of more expensive medications. It's more than a coincidence that many of the most expensive medications happen to be those medications that are most heavily advertised." In fact, between 1999 and 2000, prescriptions for the 50 most heavily advertised drugs rose six times faster than prescriptions for all other drugs, according to Katharine Greider's book, The Big Fix. So, how is direct-to-consumer advertising so effective in a system in which doctors write out the prescriptions?
Telling clever stories with misleading ads
Well, first, let's explore direct-to-consumer advertising, namely the television commercial. Most prescription drug commercials follow the same script progression: First, the commercial shows how bleak life was for a person or character before taking whatever prescription medicine the commercial is advertising. Then, the protagonist demonstrates or tells how wonderful life is while on the drug. Finally, a voiceover obligingly lists the side effects, often speaking as quickly and inaudibly as possible.
Take, for example, a Paxil commercial that was recently popular. At the beginning of the commercial, the typical 30-something-year-old woman is standing outside a house, looking through the window at the happy party going on inside. She looks so lonely and depressed that it must break nearly every consumer's heart. "What's wrong with her?" we compassionate humans gasp in unison. The voiceover answers our question as we think it: The woman has social anxiety disorder, a condition that can be treated with the prescription drug Paxil.
Suddenly, the now-medicated woman rings the doorbell and, with a huge smile on her face, joins the party. We see how much fun she is having and we are so happy for her! Of course, the voiceover quickly goes through the list of Paxil's potential side effects, but how can we concentrate on that, when we're so busy rejoicing at the woman's new happiness? Whoever wrote that commercial should write Hallmark movies. After seeing it a few times, I was convinced that most of my non-immediate family had social anxiety disorder and I even called one relative up to suggest that she take Paxil. I'm not even a gullible person, yet I was persuaded by pharmaceutical company advertising.
Doctors prescribe whatever the patient names
We are what Strand calls a "self-medicated" society. Consumers do not actually write their own prescriptions, but they practically do, based on whatever drugs they see advertised on television. Strand writes, "Surveys reported in our medical literature reveal that when a patient comes into a doctor's office and requests a specific drug that he has seen advertised in the media, the doctor writes the exact prescription the patient requested more than 70 percent of the time!"
So, let's say that a consumer who has been feeling a little sad lately sees a commercial for the antidepressant drug Zoloft. The commercial demonstrates the symptoms for depression and the consumer identifies with them. Suddenly, he or she thinks, "I'm not just sad. I'm depressed, which is a 'medical condition that can be treated by the prescription drug Zoloft.'" With this in mind, the consumer goes to a medical doctor and says, "I've been really depressed a lot lately. I've been [the consumer recites the depression symptoms listed in the Zoloft commercial]. I think I need Zoloft." So, according to Strand, there's a 70 percent chance the doctor will prescribe Zoloft, the exact prescription the consumer requested. That's how pharmaceutical commercials really work. They directly influence consumer behavior, yet drug companies claim they only "educate" patients, but don't persuade them to do anything.
Doctors are easy to manipulate, drug companies discover
You may be wondering why doctors base their prescriptions on the requests of their patients, who usually have no medical training whatsoever. That's a good question with a simple answer. The pharmaceutical-advertising machine seduces doctors, too.
According to Burton Goldberg's book, Alternative Medicine, paid pharmaceutical advertisements are the main source of the Journal of the American Medical Association's revenues. The American Psychological Association is equally under the pharmaceutical companies' spell, as 15 to 20 percent of the American Psychological Association's (APA) income comes from pharmaceutical advertisements in its journals.
In Innocent Casualties, Elaine Feuer calls these advertisements "intentionally misleading" because they promote the pharmaceutical by "exaggerating a drug's benefits while downplaying its hazards in small print in the addendum." This is very similar to the obligatory "side effects" voiceover recited at the end of a pharmaceutical television commercial; neither consumers nor doctors pay much notice to the "final voiceover" or "fine print."
Just in case advertisements in the Journal of the American Medical Association (JAMA) haven't properly seduced doctors, pharmaceutical companies take an extra promotional step by aggressively "detailing" doctors, which involves promoting drugs through door-to-door giveaways of free information and samples, according to Health Care in the New Millennium. Morrison writes that "Pfizer alone has 4,500 people in its sales force," but these employees' salaries are small change compared to the increased revenue they encourage.
The next time you watch television or read a magazine, pay special attention to pharmaceutical advertisements. Notice their promotional hooks and be grateful that you, unlike most consumers, are no longer susceptible to their influence. That's what knowledge, unlike naiveté, brings you.
The experts speak on pharmaceutical advertising:
In the pharmaceutical area, DTC advertising has been increasing in the late 1990s at a rate of around 30 percent compounded annually. Once prevented by regulation from advertising aggressively, pharmaceutical companies now see DTC advertising as a major source of stimulating demand for their product; they spent $1.3 billion on DTC advertising in 1998 alone. This has had two key effects: (1) it has built brand awareness and product awareness in the minds of end users (consumers), who are increasingly taking medications for chronic conditions in increasingly crowded and competitive therapeutic categories—cholesterol management, cardiovascular diseases, asthma, allergy, and other forms of respiratory ailments; and (2) more directly, it has encouraged users to visit their doctors and ask for the product by name.
Health Care in the New Millennium by Ian Morrison, page 44
In order to reach the widest audience possible, drug companies are no longer just targeting medical doctors with their message about antidepressants. By 1995 drug companies had tripled the amount of money allotted to direct advertising of prescription drugs to consumers. The majority of the money is spent on seductive television ads.
Death By Medicine by Gary Null PhD, page 13
In 2000, pharmaceutical companies spent $2.5 billion on mass media ads for prescription drugs. Admittedly, this is a small portion of the $101.6 billion spent on advertising of mainstream consumer products in the United States.
Ephedra Fact And Fiction by Mike Fillon, page 75
The stage could not have been set more perfectly for prescription drug advertising to become a major force in American medicine. And so it did. In 1991 the drug companies spent a paltry $55 million on advertising drugs directly to consumers. Over the next 11 years, this increased more than 50-fold to over $3 billion in 2003. The ads appeal to viewers as independent decision makers—capable of forming their own opinions about which drugs they need—and resonate with the growing concern that HMOs and managed care plans tend to withhold the best care to save money.
Overdosed America by John Abramson MD, page 81
While $3 billion in advertising may seem like an awful lot, rest assured that the drug companies aren't worried. Why? Americans are expected to spend over $500 billion on drugs this year—not including the extra $100 billion estimated for the Medicare drug benefit program. Spending on prescription drugs is now the fastest growing portion of healthcare spending in the United States.
Ephedra Fact And Fiction by Mike Fillon, page 176
Many of us don't find the amount of money spent on marketing prescription drugs to physicians surprising, but when considering the billions of dollars spent on marketing prescription drugs to the public, don't you wonder why? After all, you can obtain prescriptions only through a doctor. Pharmaceutical companies are willing to spend this kind of advertising money on only their most recently approved medication.
Death By prescription by Ray D Strand, page 48
The average number of prescriptions per person in the United States increased from 7.3 in 1992 to 10.4 in 2000. Along with this increase in demand, there has been a shift toward the use of more expensive medications. It's more than a coincidence that many of the most expensive medications happen to be those medications that are most heavily advertised.
Ephedra Fact And Fiction by Mike Fillon, page 77
According to a report prepared by the National Institute for Health Care Management, a nonprofit research foundation created by the Blue Cross Blue Shield health insurance plans, the fifty most-advertised prescription medicines contributed significantly last year to the increase in the nation's spending on drugs. The increases in the sales of the fifty drugs that were most heavily advertised to consumers accounted for almost half the $20.8 billion increase in drug spending last year, according to the study. The remainder of the spending increase came from 9,850 prescription medicines that companies did not advertise, or advertised very little. The study attributed the spending increase to a boost in the number of prescriptions for the fifty drugs, and not from a rise in their price.
Ephedra Fact And Fiction by Mike Fillon, page 77
Pharmaceutical companies are in business to make money; with the exception of over-the-counter medications that will be sold in great numbers, the only way a pharmaceutical company can make lots of money is by developing medications that can be patented. Natural herbs and foods as well as medications that can no longer be patented won't be "pushed" in advertising because there's no real money to be made on them.
Attaining Medical Self Efficiency An Informed Citizens Guide by Duncan Long, page 11
Not surprisingly the "super aspirin" have received lots of favorable press on the TV since there's money to be made. With the dollars pharmaceutical companies make, translating into greater advertising revenues for broadcasters and publishers, the rush is push the super aspirin and play up the "dangers" of common aspirin.
Attaining Medical Self Efficiency An Informed Citizens Guide by Duncan Long, page 13
The cheap-but-effective medications that can't be patented are also kept out of the limelight by the big companies paying for advertising and the mass media intent on making money through advertising.
Attaining Medical Self Efficiency An Informed Citizens Guide by Duncan Long, page 19
When you go into a pharmacy to get a prescription filled, you can often pay considerably less by choosing a "generic" drug over a brand name. The generic drugs are often made by the same manufacturer as the name-brand medication — the extra price is in the packaging and advertising. Even when a different company makes the generic medication, it is every bit as good as the brand name because it is required to meet certain standards before it can be sold in the US.
Attaining Medical Self Efficiency An Informed Citizens Guide by Duncan Long, page 183
In contrast, most physicians are unaware of the considerable risks and limited benefits of commonly used prescription cholesterol-lowering agents. In addition, since niacin is a widely available "generic" agent, no pharmaceutical company stands to generate the huge profits that the other lipid-lowering agents have enjoyed. As a result, niacin does not enjoy the intensive advertising that the HMG CoA reductase inhibitors and gemfibrozil enjoy. Despite the advantages of niacin over other lipid-lowering drugs, niacin accounts for only 7.9 percent of all lipid-lowering prescriptions.