I have authored previous articles on pharmaceutical advertisements. I noted that they used glitz to sell their products, which was not helpful to patients, especially as many new products had potentially more severe side effects than older ones and were not necessarily more effective. The only significant difference may be that newer products are more expensive.
Safety is a greater concern at present, as the Food and Drug Administration (FDA) has reduced the requirements for product safety testing before drug approval. It is now determined on an after-market basis through the public’s use of the product. That is, people are used as test subjects with fewer safeguards than were used in the past. This saves a company money and can reduce its liability if the medication causes significant damage or death.
In March, a representative for the pharmaceutical developer’s marketing organization claimed that their ads were a public service as they alerted people to drugs they might otherwise not know about. If so, then why use the promotional strategies that were used for cigarettes for decades and are now used for other tobacco products, such as vapes and pouches? Why not use methods more typical of health education, which are structured on an advisory basis and whose goal is informational, not profit-generating?
Drug advertisements are deceptive. They overemphasize their products’ possible benefits while minimizing the potential negatives. The latter are flashed on the screen briefly, in tiny print, while a speaker rapidly mentions them. How many people catch the phrases “that can lead to death” or “may be fatal” that are mentioned at least once? Of course, the image on the screen has nothing to do with the side effects and distracts the viewer’s attention from the text and the speaker. Equally given short shrift is “these are not all the side effects.”
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Before the present administration, it was routine for the Federal Trade Commission (FTC) to fine pharmaceutical companies for misleading commercials. This was of little concern to the companies, as they considered the fines a routine operating expense. These penalties were not small, and they were factored into a drug’s price.
I also find it hard to consider a medication ad as a public service when a drug has a high price. Manufacturers argue that a high price is necessary to recoup the expense of researching and developing (R&D) a drug, including all the failures that occur in the process. They do not mention that the costs of marketing and lobbying are also considered part of a drug’s price. As well, they fail to subtract the money the U.S. government provides for drug R&D from final pricing calculations. For example, taxpayers invested millions in the development of Wegovy, yet its initial pricing not only paid for the manufacturer’s R&D for its development, but for the company’s entire R&D budget for the year it was introduced to the U.S. In effect, taxpayers paid for it twice: with our taxes and with our purchases. This occurs with all new medications if a company requests R&D funding from the U.S.
If the advertisements were public service, as claimed, the companies would not only mention their drug, but also alternatives, offer comparative effectiveness, and ideally, a cost comparison. In other words, they would provide sufficient information for a consumer to make an informed choice. This, of course, is fantasy, and because the ads do not offer any comparison, they cannot be considered educational.
Especially pernicious is that pharmaceutical companies have moved onto the internet and social media. The regulations that govern advertising on traditional media do not yet apply to these. Thus, internet and social media ads can make claims that are prohibited on more traditional media, including not mentioning the ill effects.
Research on medications performed by independent organizations is often published in medical journals, making them inaccessible to most consumers. Whether these reports influence clinicians more than the rewards drug developers provide for prescribing their products has not been assessed. These emoluments are illegal, but the regulation is poorly enforced, and possibly not at all presently, and when companies are fined, they again adjust a medicine’s price to cover the penalty.
Organizations such as the Health Research Group of Public Citizen, Drugs.com, and Consumer Reports provide valuable public access to independent findings. Consumers should use this information to ask their clinicians two questions. Not whether they should receive a specific drug being advertised, but whether there is more they can do to control their condition, and whether the medication being prescribed, if it is a heavily advertised one, is the best choice for their condition, or whether an older, more established alternative might be better.
M. Bennet Broner is a medical ethicist.
