One cure for high drug prices: Ban direct-to-consumer advertising

You’re watching the evening news and you hear soft music followed by images of happy people kayaking, walking hand-in-hand, playing with kids, or even sitting in a bathtub on the beach. While the images may show healthy, active people, these are advertisements for prescription drugs that pharmaceutical companies are aiming at you to treat high cholesterol, erectile dysfunction, depression, smoking addiction, pain, sleeplessness and more.

If you believe the ads, one little pill will not just remove your suffering. It will give you a happy and healthy life.

{mosads}But the American Medical Association (AMA) recently called for a ban on direct-to-consumer advertising for prescription drugs and medical devices.

Since 1997, direct-to-consumer drug advertising has grown to account for 70 percent of total television advertising revenues. Pharmaceutical companies spent $4.5 billion dollars in direct-to-consumer (DTC) advertising last year alone. The U.S. and New Zealand are the only countries that allow such marketing. The European Union recently voted to uphold its ban.

The Republican candidates talk about repealing Obamacare. Both Democratic candidates talk about controlling the cost of pharmaceuticals through cost caps and permitting Medicare to negotiate prices with drug manufacturers.  But no one addressed one of the leading causes of increased drug costs—direct-to-consumer advertising.

In 1938, the Food & Drug Administration (FDA) was granted authority to control drugs and in 1962 they were given legislative power to control drug advertising. Physicians were the only ones who had the education and the licensure to write prescriptions. Thus, advertising was directed at the people who chose the drugs.

Only since 1985 has direct-to-consumer advertising been explicitly permitted and televisions ads took off in 1997 when the FDA weakened requirements for fairness and reporting risks.

In my 15 years of teaching and writing in bioethics and health policy, I have often asked, why do drug companies want to advertise directly to consumers?

The answer is simple. Such efforts work.

A recent Kaiser Family Foundation poll found that 28 percent of consumers asked doctors specifically about a drug they saw advertised and 12 percent stated that their doctor prescribed the requested drug.

A 2014 study in the journal Medical Care found that patient requests for specific drugs “substantially affected physician-prescribing decisions” even when it was not necessarily the best treatment option. In 1988, drug costs were $41.9 billion ($85.3 billion in 2015 dollars) and accounted for 7.8 percent of national health expenditures. In 2014, those costs were $374 billion and in 2013 were 9.3 percent of health expenditures.

FDA rule changes were a result of drug companies wanting direct access to consumers and a cultural shift in the physician-patient relationship. Rather than patients following physician orders, patients wanted more self-determination in their medical treatment.

There are some good reasons for direct-to-consumer contact: patients are informed of new options and they have information when talking to a physician. Previously, the physician was the gatekeeper to not only the drug, but also even knowledge that the drug existed.

However, there are even more reasons against direct-to-consumer ads. They are biased and misinform patients. For example, such ads tend to overemphasize the benefits of a drug, diminish knowledge of side effects, and neglect to discuss alternatives.

DTC can influence patients to demand drugs before its effects are fully known. Even after clinical testing, only a few thousand people at most have received the drug. Once it is prescribed to tens of thousands or millions, more side effects are found.

Consider rofecoxib (Vioxx) which was heavily promoted, heavily prescribed, and turned out to be a cause of heart attack and stroke without providing much benefit over existing therapies.  Another example is Fen/Phen, a combination of drugs that was prescribed for weight loss and caused severe heart damage. Both drugs were removed from the market.

Direct-to-consumer ads can cause damage to the physician-patient relationship when a doctor refuses to prescribe a drug the patient is convinced he or she needs but the doctor does not see as beneficial or even relevant to the patient’s conditions. For the same reason, some doctors will simply prescribe the requested drug to keep harmony and to keep a paying patient in his or her practice.

These ads waste money through unnecessary prescriptions, lost appointment times for drugs the patient does not need, and from increasing costs of health care. Companies advertise the latest and most expensive drugs when in many cases, older pharmaceuticals that are available in less expensive generic form may be just as good, if not better.

First, we need to take the AMA’s lead and urge the FDA to reinstate the ban against direct-to-consumer advertising. Not only does the risk of prescribing via television  outweigh the benefits, but the information purportedly passed to consumers is easily available on the internet and through doctors.

After all, even with these ads, doctors are still the gateway to being able to purchase a prescription drug. Second, we need to ask our doctors what they think is best for our condition rather than walking in demanding a pill based on an ad that presents a pretty lifestyle.

Klugman is a professor of bioethics and chair of the Department of Health Sciences at DePaul University. He serves on the ethics committee at Northwestern Memorial Hospital, is the blog editor for, and is a public voices fellow with The OpEd Project.


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