Direct to consumer (DTC) pharmaceutical ads are only allowed in two countries across the world, the USA and New Zealand. In 2015, Big Pharma spent $5.4 billion in DTC ads. The major TV networks, CBS, ABC, NBC and Fox received most of this. At the top of the list was CBS with $511 million.
So do the ads work? A 2011 Report by the Congressional Budget Office found that “Drugs with DTC ads had nine times more prescriptions than those that did not.” Yes, these ads are driving customers!
But the advertising spend is just one piece in a full court press in order to influence news programs. Award winning investigative journalist, Sharyl Attkisson shares details of what she calls “pushback” from corporate interests while she worked at CBS. In her book, Stonewalled, she details many examples such as Ford Explorer rollovers with Firestone tires. She also talks about pharmaceutical companies, which you’ll hear in the episode.
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Medical Monopoly Musings #48
Direct to Consumer Pharmaceutical Advertising
Direct to consumer (DTC) pharmaceutical ads are only allowed in two countries across the world, the USA and New Zealand.
The FDA relaxed rules in 1980 for DTC pharma ads. Then in 1997, the FDA lessened regulations for the industry even more. It is here that we saw these ads become widely prevalent in the US.
In 2015, Big Pharma spent $5.4 billion in DTC ads. The major TV networks, CBS, ABC, NBC and Fox received most of this. At the top of the list was CBS with $511 million.
Make no mistake. DTC ads are only a small portion of their marketing budget. We’ll cover the other marketing aspects in future issues.
Here’s the top drugs advertised in 2015 by ad spend.
A common myth spouted by the drug companies is they must charge so much money to fund research costs. The truth is most of their drug research starts from publicly funded science. Furthermore, they’re one of the most profitable industries. And they spend significantly more on sales & marketing than on R&D.
A spokeswoman for the industry trade-group PhRMA said “Providing scientifically accurate information to patients so that they are better informed about their health care and treatment options is the goal of direct-to-consumer pharmaceutical advertising about prescription medicines. Beyond increasing patient awareness of disease and available treatments, DTC advertising has been found to increase awareness of the benefits and risks of new medicines and encourage appropriate use of medicines.”
The industry says that these ads are for educating the public. To this Diana Zuckerman, President of the National Center for Health Research, said, “If the real goal is to educate, they wouldn’t look like this. The goal is to persuade. These ads educate people as much as the ads for the GAP or ads for makeup educate. It is educating you to tell you that this product exists and that it's great.”
So do the ads work? A 2011 Report by the Congressional Budget Office found that “Drugs with DTC ads had nine times more prescriptions than those that did not.” Yes, these ads are driving customers!
In a study looking at this, Frosch, et al. found that “This advertising has some benefits, but significant risks are evident as well.” As this model shows the advertising leads to a variety of outcomes.
Even the American Medical Association wants to stop DTC advertising, changing their position in 2015.
According to Jerry Avorn, of the New York Times, DTC “advertising promotes only the most expensive products, it drives prescription costs up and also encourages the 'medicalization' of American life — the sense that pills are needed for most everyday problems that people notice, and many that they don’t.”
As you can imagine the scientific complexity of a drug is hard to cover in a one minute commercial. In 2002, AstraZeneca came under fire for their drug, tamoxifen, for overstating the benefits and understating the risks. The FDA didn’t respond to the ad for six months.
“The FDA regulations are drafted and enforced in such a way that encourages drug companies to cross the line — with a lack of resources to identify violations and enforcing these regulations,” said Barbara Brenner, executive director of Breast Cancer Action. “They do not have the resources to monitor drug ads prior to publication, so the burden of monitoring these ads then falls on the public.”
And there is one other big benefit to the drug companies that this advertising buys. We’ll dive into that next time…
References:
https://www.statnews.com/pharmalot/2015/11/17/pharmalot-ama-drugs/
https://www.drugwatch.com/featured/big-pharma-marketing/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791253/
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Medical Monopoly Musings #49
Advertising and Harassment Influence News Programs
Last time we covered how direct to consumer (DTC) advertising influences consumers into using more pharmaceutical drugs. This is one in many steps that have led to increased medicalization.
In 2015 we saw $5.4 billion in spend on TV ads. The rates of these ads are ever increasing. The first half of 2018 saw a 6% increasing in TV ad spend in large part aided by Big Pharma which increased its ad budget by 17%. It is possible it is close to $10 billion in 2020.
With TV, ads are marketing to the elderly population which are the people that are still watching (as opposed to younger generations which get their media online…where advertising is also increasing).
But the advertising spend is just one piece in a full court press in order to influence news programs. Award winning investigative journalist, Sharyl Attkisson shares details of what she calls “pushback” from corporate interests while she worked at CBS. In her book, Stonewalled, she details many examples such as Ford Explorer rollovers with Firestone tires. She also talks about pharmaceutical companies…
“Resisting the pushback [on a news report about drug safety], we air the story as planned and [Executive Producer Jim] Murphy asks for more. We continue digging into FDA-approved prescription drugs that are allegedly proving problematic from a safety standpoint.
“When we do, hired guns for pharmaceutical interests flood me and CBS News with emails, phone calls, and requests for meetings. They write letters to CBS attorneys. The spokesman for the Secretary of Health and Human Services Tommy Thompson calls the CBS News Washington bureau chief to exert pressure to discredit our stories. Pharmaceutical company lawyers set up secretive meetings with CBS officials in New York. Pharmaceutical interests contact CBS executives to complain.
“At one point, when I’m covering safety concerns about the highly profitable cholesterol drugs known as ‘statins,’ whose makers buy advertising on CBS, Murphy receives what he views as a harsh threat from one of the CBS sales bosses. The manager leaves Murphy a loud, angry voice mail saying that the stories could ‘really harm business.’
“My producer and I are also receiving direct pressure from news executives in New York who begin unnaturally inserting themselves into the newsgathering and approval process for the pharmaceutical-related stories as they had never done with me before. Even after our scripts go through the normal editorial process and receive approval from the legal department, the executives enter to dissect and question each fact and sentence…an executive confesses to me in frustration that she’s been given a mission of trying to stop my stories.”
Notice that there are several tactics used by the pharmaceutical interests here. Advertising, and the threat of pulling ads, is just one tool of many. Others include legal action, political allies, harassment, and more. In other sections she also mentions pushback from industry front groups or astroturf organizations.
It was problems like these that caused Sharyl to leave CBS and become independent. The reason I follow her work is that she is actually a great journalist that does not succumb to these pressures. (She’s now labeled a rightwing conspiracy theorist by her detractors of course…despite the above stories occurring during the Bush administration.)
Next time, we’ll dive into the power of an interlocking directorate which may be the biggest reason that mainstream journalism is as broken as it is today. It’s really not often the journalists themselves but the managerial and executive layers where we need to look.
References:
https://www.drugwatch.com/featured/big-pharma-marketing/
https://magnaglobal.com/magna-advertising-forecasts-fall-update-executive-summary/
Attkisson, S. (2015). Stonewalled: My fight for truth against the forces of obstruction, intimidation, and harassment in Obama's Washington (pp. 69-70). New York: Harper.
