Should pharmaceutical advertising be banned?

In many countries, direct to consumer advertising (DTCA) of prescription drugs is either prohibited or tightly restricted.  The United States is a notable exception, along with New Zealand.  For tv ads, the standard pattern is to talk about the illness, talk about the amazing benefits of the drug, and then provide the required long list of side effects in an upbeat tone of voice while cheerful music plays and people are shown happily living their wonderful lives.  The ad closes with something along the lines of “ask you doctor if _____ is right for you”.  If you haven’t seen one of these ads before, there are a couple of examples at the end of this post.

Drug company marketing to health care providers is a related but distinct issue that’s deserving of its own post, so I’ll set it aside for the sake of this post and focus solely on issues around DTCA.

Wikipedia cites a study that reported expenditures in the U.S. grew from $1.1 billion in 1997 to $4.2 billion in 2005.  In the last ten years, four major pharmaceutical companies have reached settlements of greater than $1 billion with the U.S. Food and Drug Administration (FDA) over allegations of illegal marketing.  Psychiatric medications were among the drugs involved in all of these settlements.  Prescription drug ads do not need to be pre-screened by the FDA before they can be printed or broadcast, so even if an ad is later found to be in violation of the laws, it will have already been seen by large numbers of consumers.

In Canada there’s a loophole of sorts that allows marketing of drugs as long as there’s no mention of what medical condition the drug is used for.  In 2006 the independent Health Council of Canada published a report looking at at the public health implications associated with direct to consumer advertising of prescription drugs.  They recommended closing this loophole and prohibiting all DTCA of prescription drugs.

What are the potential benefits?

Clearly the winner here is the drug companies themselves.  But what are the supposed benefits to consumers from this kind of advertising?  According to the Health Council of Canada report, some of the benefits that are claimed are consumer education, increased autonomy in health care decision making, earlier diagnosis of illnesses, and increased medication compliance.

Public service announcements may be educational, but commercial advertisements are not.  Whether its drugs or laundry detergent, the purpose is to sell a product.  Any information that is gained through commercial advertising is only to support the primary sales purpose and will likely heavily biased.

In terms of autonomy, I’m not sure that going to the doctor and requesting drug X truly represents autonomous decision making.  In fact, if patients are forming spurious judgments about the state of their health and the treatment they need, they lose the true autonomy that comes from getting a well-reason diagnosis and being presented with appropriate treatment options in a way that allows them to make informed decisions.

As for earlier diagnosis, this brings to mind issues with misleading Paxil advertising that essentially claimed that everyone (and probably their dog too) had social anxiety disorder and needed to be medicated.  Social anxiety is a very real and potentially debilitating condition, but the makers of Paxil were casting a much wider net than that.  People who are unwell will make their own decisions about whether or not to seek medical help, but there’s no need for the masses to go rushing to their doctor asking for drugs because pharmaceutical marketing campaigns told them they were most likely sick.

I fail to see how compliance could be improved, unless the line of thinking goes that if a patient asks their doctor for drug X (whether they need it or not), they’re more likely to take drug X?  Or does seeing a Pristiq ad on tv remind someone that they forgot to take their medication that morning?  It all seems like a rather flimsy argument.

What are the potential harms?

According to studies cited in the Health Council of Canada report, direct-to-consumer advertising influences both patient demand and physician prescribing.  A study of general practitioners in New Zealand found that almost 70% felt pressured by their patients to prescribe medications.  A study conducted in the U.S. and Canada found that when patients went into an appointment requesting a drug, they were 17 times more likely to be prescribed a drug by the end of that appointment.

Pharmaceutical ads that claim Drug X is wonderful for condition Y are targeting consumers who likely don’t have the medical knowledge base to determine whether Drug X is in any way appropriate for them, and may have no idea if they actually have condition Y or not.  If they go to their doctor requesting Drug X, a prescriber may order Drug X rather than the more appropriate Drug Z in order to appease the patient, or they may try to appease the patient by giving them Drug X even though they don’t actually meet the full diagnostic criteria for condition Y.  While this may seem like poor practice on the part of physicians, it’s certainly not unheard of.  As an example, overprescribing of antibiotics is driven in part by patients who are going in to see their doctor and demanding antibiotics even though they most likely have a viral illness that antibiotics will do nothing for.  Doctors are busy enough without having to spend time trying to re-educate patients who have been misinformed by drug company ads.

 

Decisions about an individual’s medication treatment should be made by that person and their healthcare providers based on their specific health concerns.  Pharmaceutical companies should not have the opportunity to interfere in that process.  The whole reason drugs are prescription only is that medical professionals need to determine whether or not they are appropriate for a given patient.  If patients are going into their medical appointments having actually researched treatment options, that’s great, but watching a pharmaceutical ad is not research.  It’s a sales pitch.

A 2013 opinion piece in the New York Times says that “biased pill-pushing messages are a public health menace.”  I agree, and it would be nice to see regulators in the U.S. and New Zealand stand up to the powerful pharmaceutical lobby and put an end to direct to consumer advertising.  Sales tactics have no place in mental health care.

 

What are your thoughts?

 

Sample ads posted on Youtube:

 

psych meds made simple

 

My first book, Psych Meds Made Simple: How & Why They Do What They Do, is now available on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!

Is “natural” better when it comes to health?

Recently I watched an episode of the Netflix docuseries A User’s Guide to Cheating Death that challenged the idea that “natural” is always good for you.  I also saw a post by Trish on The Introspective Salon on the same topic, so I decided to throw in my own two cents about the issue of whether “natural” is actually a good thing.

“Natural” is not a term that’s regulated in any way, so if a product claims to be natural on its label that should be taken with a grain of salt because it’s essentially meaningless.  If we take natural to mean things that are normally found in nature, we’re talking about an extremely broad range of substances.  There seems to be this idea floating around that natural is always better, except it ignores a whole lot of not so nice things that are found in nature.

One need look no farther than the basic elements like arsenic, lead, and radon, or a simple compound like hydrogen cyanide.  There are many plant and fungal species that are toxic to humans, along with venom and other toxic compounds from critters like snakes and pufferfish.  Plus there’s all the non-toxic but just a bit yucky things that nature comes up with.  Then again, maybe I should be marketing ground-up guinea pig poop as some sort of healing product.

Some people take it to extremes.  In Canada a few years ago, two parents were convicted of failing to provide the necessaries of life after their infant son died of meningitis.  Rather than seeking medical attention for him, they were trying to cure him with herbal and dietary supplements.  Other harmful “natural” techniques that some parents inflict on their kids include administering substances like bleach with the belief that it will supposedly treat autism

Like Trish mentioned, it’s easy to find people attacking the big pharma machine, but the same critical eye isn’t being directed toward the natural products industry.  These supplements may be “natural”, but they’re also big business.  According to GrandView Research, global sales of dietary supplements in 2016 were valued at $133.1 billion USD.  Not only is there big money involved, but they also don’t have to go the same stringent regulatory process that prescription drugs go through.

In Canada, natural supplements fall under Health Canada’s Natural Health Products Regulations.  Health Canada assesses “whether there is reasonable assurance that benefits of the product outweigh any risk” and whether there is evidence to “support the reasonable association of the medicinal ingredient(s) with the health claim(s) and demonstrate that therapeutic efficacy of the product will be supported by at least one medicinal ingredient or the combination of more than one.”  The requirements are even looser for products used as “traditional medicines”.

The U.S. Food and Drug Administration (FDA) uses the term “dietary supplements“.  It seems to take a fairly hands off approach:

“Federal law does not require dietary supplements to be proven safe to FDA’s satisfaction before they are marketed.”

“For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA’s satisfaction that the claim is accurate or truthful before it appears on the product.”

Essentially, you could be something that may or may not contain the amount of a substance that it says it has, and it may or may not do what it claims to do.  The consumer isn’t given any idea of other substances that it may interact with.

That’s not to say that we should dismiss these natural supplements entirely.  Some vitamins, minerals, and other supplements are useful for certain populations.  There is scientific evidence to support certain claims, like omega-3 fatty acids being helpful for mood disorders.  Unfortunately, it’s hard to separate out the fact from the fiction without doing some in-depth research, and even if there is some scientific fact underlying a claim it doesn’t mean that the interpretation hasn’t blown things out of proportion.

I liked A User’s Guide To Cheating Death, but at times it seemed to go a little too far in the anti-natural direction.  I don’t think that extreme views in either the anti-natural or anti-drug direction are particularly useful.  It’s  possible to be a discerning consumer and at least try to separate the solid evidence from the hype and marketing; it’s just a matter of keeping that radar active just as much for natural products as for drugs.