Monday, January 14, 2019

Medicine meets Madison Avenue

Today’s post was prompted by a UPS delivery. A big brown truck pulled up and the driver handed me a large but light cardboard box. In the box was a rolled-up poster with sticky tabs at each corner and a cover letter from WedMD suggesting that I hang the poster in my exam room “for the benefit of my patients and their families.” The top 2/3 of the poster had marginally useful information about the common cold and the lower third had pictures of name brand OTC cold remedies and the CVS logo. Useful? Maybe. Promotional? Clearly.
This delivery did provide a great segue into discussion of a paper published in the January 1, 2019 edition of the Journal of the American Medical Association titled “Medical Marketing in the United States 1997-2016.” Advertising has been with us for a long time, and it clearly works. Google’s billions are earned by its ability to target adds to potential customers. In the medical domain, direct-to-consumer (DTC) ads have been clearly linked to both higher demand for and prescription of advertised products. It is thus no wonder that spending on DTC advertising rose from $2.1 billion in 1997 with 79,000 ads to $9.6 billion in 2016 with 4.6 million ads, including 663,000 television commercials. As I note in Prescription for Bankruptcy, the TV ads have a common format. A sad subject, often videoed in muted colors or black and white, bemoans their inability to care for their family or enjoy life. Enter the magic potion and the sun shines, bright colors appear and their life is restored. This is followed by a rapid reading of the mandated side effects that are clearly outweighed in the viewer’s mind by the benefits. Nowhere in the ads are the magnitude of benefits mentioned, which are often small, nor any alternative treatments.
A more recent addition to the advertising armamentarium has been “disease awareness campaigns.” While these can be helpful in destigmatizing diseases such as mental health problems and HIV, more often they simply drive people to demand treatment for conditions that do not respond to the suggested treatment – think “Low T,” driving men to demand testosterone replacement for normal aging
Even larger sums are spent on marketing of pharmaceuticals to physicians, though this has always been a focus of the drug companies and so the increase in spending is less dramatic. In 1997, $15.6 billion was spent marketing pharmaceuticals to health professionals, and in 2016 this had risen to $20.3 billion. This includes samples (always for new and expensive products), coupons and visits by “detail reps” bringing lunch to doctors’ offices. While doctors will generally insist (and may even believe) that they cannot be influenced by a free lunch, ample data exists to show that the opposite is true. Numbers of targeted prescriptions written track closely to the number of meals provided.
Now joining the ranks of pharmaceutical companies in delivering DTC ads are many hospitals and cancer centers. These ads typically tout “new” high tech procedures such as robotic surgery even when there is no clear scientific evidence that these procedures offer any benefit over established techniques. Cancer centers often provide testimonials from satisfied patients rather than meaningful outcomes data.
Knowing that detail reps are no more providing unbiased data than are car salesmen, doctors should refuse to accept their visits, as many academic centers now insist. Advertising is probably here to stay. It clearly provides return on the dollar, and in the US (one of only two countries in the world to allow DTC pharmaceutical adds; the other is New Zealand), courts have declared such ads to be allowed under freedom of speech. What I hope the FDA and/or FTC will do is insist that such ads be more factual. If a new drug is only marginally better than an old one, this should be spelled out in specifics. If a new procedure is more expensive but has not been shown better than other forms of treatment, this needs to be clearly stated. Putting your health on the line has much greater consequences than which laundry detergent you buy, and Madison Avenue must be forced to accept this.

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