Retired physician here. These ads have been one of my worst irritants and should never have been allowed. Since corporations are people, and since most of our legislators are bought by the pharmaceutical companies, the chances of change are minuscule. This is a very good writeup of the situation, including the unlikelihood of change. What a country!
YLE is right about the first amendment barrier to an outright ban. And she’s also right that stiff regulation of DTC drug ads requiring full disclosure of potential adverse effects will be very effective workaround.
Having had a primary care practice of General Internal Medicine for 30+ years I've been thru all of these Pharma promos - office lunches (not real high class nor heavy but persistent even if I didnt prescribe the "latest and greatest" statin. Once upon a time, I was challenged by a drug rep as to why I didn't prescribe their new product. I just assumed she was only speaking generically when I discovered through our state pharmacy board that big pharmacist were paying pharmacies for their list of physicians prescribing specific drugs, and therefore, she knew precisely when and how much of their product I was prescribing. Namely, none. I explained my reasoning, but that went into deaf ears, I believe. I really didn't have any idea how long that surreptitious sleuthing had been active, but soon ceased with a directive from the state. We cannot depend on the pharmaceuticals to police themselves as to ethics and morality as I view it. If only the US and New Zealand bar advertising, we are in the 4th standard deviation for common sense on this globe and our health statistics do not match many other first world countries. I once asked a rep why they advertised on TV when I personally had never had a patient inquire or insist on a drug they had seen advertised. It sells she replied. My patients trusted my knowledge of pharmacology and my medical skills so why would they? Would you feel totally confident in a billboard ad promoting a Medical Doctor wearing a silk suit and flashing his pearly white teeth? Yeah, I know, I'm old old school.
We are both old school. I have some medical education, from working toward a masters degree in occupational therapy (never completed), and from working in group health insurance, where I dealt with one of the company doctors on a regular basis. Because of my background, I know whether I can trust what my doctors are saying, and/or I can ask good questions. IMO our country is too focused on external appearances and not enough on the deep, real information.
Truthfully, I suspect no patient information was provided thru the transfer of the name of the drug and name of the prescriber. That would be a HIPPA issue for sure. It's the very idea that marketing drugs can be so devious and the prescriber doesnt have a clue what has happened behind the scene. Pharmas spend big bucks with advertising and user data gathering. Anyone that says such advertising doesn't trickle down to the cost of the drugs is rather naïve, I should think. It's a business expense, you might say? OK, then the taxpayers ultimately pay for those million dollar "dancing fat people" ads.
Part of what went into banning of tobacco ads on television many years ago was that the tobacco industry voluntarily agreed to abide by the legislation and not challenge it in court (it was also in the early 1970s, before the Supreme Court created the doctrine of commercial speech). More recently, the tobacco industry agreed to change its advertising practices as part of a major settlement of litigation. In the case of drug ads, it is hard to imagine the drug industry going along with an advertising ban (the drug industry spends about $20-30 billion/year on advertising to prescribers and patients). As an indicator of what might happen without industry agreement, the tobacco industry has been working hard to try to prevent the FDA from imposing more realistic packaging of cigarettes that it doesn't want and has used litigation to delay and block new packaging for upwards of 15 years now.
loathe to confess that I agree with RFK Jr on this one. Having spent my entire career in big pharma doing oncology drug R&D with several drugs coming to market, I have always found DTC advertising disgusting. My European colleagues are appalled by the commercialization of best medical practices to lay consumers.
I agree that it could be a change for the better. It defies common sense that a drug or device, which has to be prescribed by a licensed clinician, could be advertised to the general public. (Public service announcements, like “It’s time to be immunized to protect you from flu,” don’t tout specific products.) We can hope for the best. But unless it has real consequences that survive the big money lobbying, court challenges on First Amendment rights, and are enforced, it’s pie in the sky.
During my decades in medical practice, I was impressed by how much the drug companies spent on trying to build my loyalty to their brands -- lucrative trips to the podium, dinners at fancy digs, bright and sometimes flirty reps wanting to spend time with me. It left me wondering if my colleagues had time for any other sources of research updates.
Well, I for one have always found them side-splitting. By the time they've finished with the list of adverse reactions, it's a wonder anyone is inspired to "ask the doctor".
Much more insidious now are the charlatan products advertised by wanna be home remedy manufacturers, especially the ones that claim they "do the research". But, MAHA rules.
There is precedent for banning these drug ads. I don't remember the exact year however I think it was 1971. Maybe most of your readers were not born yet. I was 20. Anyway, it was way back in time that one could expect to see every other TV ad promoting cigarettes.
The Marlboro Man. Lucky Strike (LSMFT… Lucky Strike Means Fine Tobacco). Countless Menthol cigarette brands aimed mostly at black men. The list goes on.
Then suddenly they were all gone. I don't remember whether or not the tobacco industry, one of the oldest and most powerful in the US challenged this in the courts. Regardless, the ban has endured for over 50 years. So maybe drugs can get the same treatment.
I would love to see that. We tend to watch recorded programs and fast forward through the ads, but one thing I've noticed is that when I do pay attention to them, I have no idea what the drugs are for most of the times. They probably mention it before my attention gets focused. The only drugs that are obvious are the ones with the bananas or the curved carrots.
But there is an important difference, which is that, whereas in even earlier decades cigarettes were believed to have health benefits, it became clear that they are always, and only, harmful. The same can't be said of pharmaceuticals.
*political TV ads, I believe, were a huge reason it got so expensive to run a campaign. Now, of course, we're mostly past the era of political TV ads, and on to the social media and influencer age.
What has always confounded me was the statement made at the end of most pharmaceutical ads that goes something like this: " Don't take <drug name> if you are allergic to <drug name>." How on earth would I know if I'm allergic to it if I've never taken it?
I doubt this is about protecting the public. Have you seen this administration doing anything without an ulterior motive? This is a stick with which they can threaten pharma and extract some concessions.
I am in the patient population for a significant number of those ads.
One particular type greatly disturbs me, add-ons for depression treatment. The claim is that these drugs will make ineffective or partially effective depression meds work better. The drugs, however are antipsychotics, medications developed for treatment of psychosis, especially schizophrenia. These are dangerous drugs with major, life altering side effects, and they require ongoing monitoring with blood tests and face-to-face monitoring once a month.
Ordinarily, when an antidepressant is inadequate in treating depression, the next step is to add a mood stabilizing drug, not an antipsychotic. That is not what the ads are promoting. There are times when an antipsychotic makes sense without a mood stabilizer and that is when the patient begins reporting hallucinations (usually hearing voices.) It can happen.
Unfortunately, the doctors who are most likely to be asked for these drugs are general and family practitioners. They prescribe most antidepressants, proportionately, but they have no training in psychotropic drugs.
I personally disapprove of GPs prescribing antidepressants, but I understand it. Adverse side effects for antidepressants are rarely life-altering and even when they are, they are easy to spot. They do not require blood tests and patients or family members are likely to report problems.
In contrast, with antipsychotics the normal, expected side effects can be life threatening and require lifestyle changes from day one. The *adverse* side effects can be very difficult to spot, the patient is unaware of them, and they are irreversible. Monthly face-to-face monitoring is important. There are not many drugs in any class where this is the necessary. Usually, you stop the drug and the side effect stops. Not so with antipsychotics. The effects, once they start, are permanent. They are also very common and with extended use, nearly universal. These patients require careful monitoring.
Advertising these drugs to people who are most likely to request them from someone other than a psychiatrist is unethical, at best. That is not the case with anti-cancer drugs or biologics used to treat autoimmune disorders. Those patients receive care from specialists, but most people with depression do not.
I have no formal education in pharmacy. But I had a liberal arts bachelor’s degree before I was diagnosed with a major psychiatric disorder 30 years ago. So I learned. Being educated about psychiatric drugs is essential for managing my life. Most psychiatric patients do not have the privilege of higher education because of how and when the disorders occur. Most of us with severe mental illness have limited employment options, if any. We have limited social lives. Discrimination is normal. This makes those ads insulting, and predatory, as well as unethical.
The key paragraph here is “does this have teeth.” This administration is all about optics and sound bites, with little regard for crafting actual laws and policies; so far RFK Jr hasn’t demonstrated even a basic understanding of his job, and he’s fired all of the people with real knowledge, skills and experience. So I think this is a big “nothing burger.”
As a retired pharmacist with an advanced degree, I have long been opposed to direct to consumer advertising for medications, for all of the reasons discussed in the post, and from personal experience “counter educating” what a patient “learned” by a google search or an ad.
I am one of those (probably rare) people who asked for the drug insert in addition to the patient information. Unfortunately, they are frequently not available any more. Digging through online trash has gotten harder because there is so much more of it. Thankfully I have an older, well seasoned pharmacist who can answer questions and provide insight. (I will never talk politics with him though!!)
One positive aspect of many current drug ads: they feature great musical numbers with a bevy of dancers who all look like they could use the exercise. We need more of that!
Another reason Big Pharma is immune from any real curbs on their advertising, which could eat into their profits: pretty much everybody's retirement portfolio has substantial stock holdings in Big Pharma.
No one wants that particular golden goose to stop laying eggs - including, in all candor...me.
Retired physician here. These ads have been one of my worst irritants and should never have been allowed. Since corporations are people, and since most of our legislators are bought by the pharmaceutical companies, the chances of change are minuscule. This is a very good writeup of the situation, including the unlikelihood of change. What a country!
What a country indeed
YLE is right about the first amendment barrier to an outright ban. And she’s also right that stiff regulation of DTC drug ads requiring full disclosure of potential adverse effects will be very effective workaround.
Having had a primary care practice of General Internal Medicine for 30+ years I've been thru all of these Pharma promos - office lunches (not real high class nor heavy but persistent even if I didnt prescribe the "latest and greatest" statin. Once upon a time, I was challenged by a drug rep as to why I didn't prescribe their new product. I just assumed she was only speaking generically when I discovered through our state pharmacy board that big pharmacist were paying pharmacies for their list of physicians prescribing specific drugs, and therefore, she knew precisely when and how much of their product I was prescribing. Namely, none. I explained my reasoning, but that went into deaf ears, I believe. I really didn't have any idea how long that surreptitious sleuthing had been active, but soon ceased with a directive from the state. We cannot depend on the pharmaceuticals to police themselves as to ethics and morality as I view it. If only the US and New Zealand bar advertising, we are in the 4th standard deviation for common sense on this globe and our health statistics do not match many other first world countries. I once asked a rep why they advertised on TV when I personally had never had a patient inquire or insist on a drug they had seen advertised. It sells she replied. My patients trusted my knowledge of pharmacology and my medical skills so why would they? Would you feel totally confident in a billboard ad promoting a Medical Doctor wearing a silk suit and flashing his pearly white teeth? Yeah, I know, I'm old old school.
We are both old school. I have some medical education, from working toward a masters degree in occupational therapy (never completed), and from working in group health insurance, where I dealt with one of the company doctors on a regular basis. Because of my background, I know whether I can trust what my doctors are saying, and/or I can ask good questions. IMO our country is too focused on external appearances and not enough on the deep, real information.
There are not enough people like you! Thank you for what you do.
Thank you, Joan!
That sounds awfully close to a HIPAA violation to me.
Truthfully, I suspect no patient information was provided thru the transfer of the name of the drug and name of the prescriber. That would be a HIPPA issue for sure. It's the very idea that marketing drugs can be so devious and the prescriber doesnt have a clue what has happened behind the scene. Pharmas spend big bucks with advertising and user data gathering. Anyone that says such advertising doesn't trickle down to the cost of the drugs is rather naïve, I should think. It's a business expense, you might say? OK, then the taxpayers ultimately pay for those million dollar "dancing fat people" ads.
Yeah, ya gotta hope they're careful with patient info.
Part of what went into banning of tobacco ads on television many years ago was that the tobacco industry voluntarily agreed to abide by the legislation and not challenge it in court (it was also in the early 1970s, before the Supreme Court created the doctrine of commercial speech). More recently, the tobacco industry agreed to change its advertising practices as part of a major settlement of litigation. In the case of drug ads, it is hard to imagine the drug industry going along with an advertising ban (the drug industry spends about $20-30 billion/year on advertising to prescribers and patients). As an indicator of what might happen without industry agreement, the tobacco industry has been working hard to try to prevent the FDA from imposing more realistic packaging of cigarettes that it doesn't want and has used litigation to delay and block new packaging for upwards of 15 years now.
Thank you for this great piece. I am
loathe to confess that I agree with RFK Jr on this one. Having spent my entire career in big pharma doing oncology drug R&D with several drugs coming to market, I have always found DTC advertising disgusting. My European colleagues are appalled by the commercialization of best medical practices to lay consumers.
I agree that it could be a change for the better. It defies common sense that a drug or device, which has to be prescribed by a licensed clinician, could be advertised to the general public. (Public service announcements, like “It’s time to be immunized to protect you from flu,” don’t tout specific products.) We can hope for the best. But unless it has real consequences that survive the big money lobbying, court challenges on First Amendment rights, and are enforced, it’s pie in the sky.
During my decades in medical practice, I was impressed by how much the drug companies spent on trying to build my loyalty to their brands -- lucrative trips to the podium, dinners at fancy digs, bright and sometimes flirty reps wanting to spend time with me. It left me wondering if my colleagues had time for any other sources of research updates.
Well, I for one have always found them side-splitting. By the time they've finished with the list of adverse reactions, it's a wonder anyone is inspired to "ask the doctor".
Much more insidious now are the charlatan products advertised by wanna be home remedy manufacturers, especially the ones that claim they "do the research". But, MAHA rules.
There is precedent for banning these drug ads. I don't remember the exact year however I think it was 1971. Maybe most of your readers were not born yet. I was 20. Anyway, it was way back in time that one could expect to see every other TV ad promoting cigarettes.
The Marlboro Man. Lucky Strike (LSMFT… Lucky Strike Means Fine Tobacco). Countless Menthol cigarette brands aimed mostly at black men. The list goes on.
Then suddenly they were all gone. I don't remember whether or not the tobacco industry, one of the oldest and most powerful in the US challenged this in the courts. Regardless, the ban has endured for over 50 years. So maybe drugs can get the same treatment.
I would love to see that. We tend to watch recorded programs and fast forward through the ads, but one thing I've noticed is that when I do pay attention to them, I have no idea what the drugs are for most of the times. They probably mention it before my attention gets focused. The only drugs that are obvious are the ones with the bananas or the curved carrots.
Of course, that's the first thing I thought of, too (and I've often thought of it, as I've been saying for decades that political ads on TV should be banned, as they're harmful to our political health*). Here's a little history of the cigarette ads ban: https://www.politico.com/story/2018/04/01/congress-bans-airing-cigarette-ads-april-1-1970-489882
But there is an important difference, which is that, whereas in even earlier decades cigarettes were believed to have health benefits, it became clear that they are always, and only, harmful. The same can't be said of pharmaceuticals.
*political TV ads, I believe, were a huge reason it got so expensive to run a campaign. Now, of course, we're mostly past the era of political TV ads, and on to the social media and influencer age.
What has always confounded me was the statement made at the end of most pharmaceutical ads that goes something like this: " Don't take <drug name> if you are allergic to <drug name>." How on earth would I know if I'm allergic to it if I've never taken it?
I doubt this is about protecting the public. Have you seen this administration doing anything without an ulterior motive? This is a stick with which they can threaten pharma and extract some concessions.
You're assuming anything will, in fact, be done. This is just more cosplay from these bozos.
I am in the patient population for a significant number of those ads.
One particular type greatly disturbs me, add-ons for depression treatment. The claim is that these drugs will make ineffective or partially effective depression meds work better. The drugs, however are antipsychotics, medications developed for treatment of psychosis, especially schizophrenia. These are dangerous drugs with major, life altering side effects, and they require ongoing monitoring with blood tests and face-to-face monitoring once a month.
Ordinarily, when an antidepressant is inadequate in treating depression, the next step is to add a mood stabilizing drug, not an antipsychotic. That is not what the ads are promoting. There are times when an antipsychotic makes sense without a mood stabilizer and that is when the patient begins reporting hallucinations (usually hearing voices.) It can happen.
Unfortunately, the doctors who are most likely to be asked for these drugs are general and family practitioners. They prescribe most antidepressants, proportionately, but they have no training in psychotropic drugs.
I personally disapprove of GPs prescribing antidepressants, but I understand it. Adverse side effects for antidepressants are rarely life-altering and even when they are, they are easy to spot. They do not require blood tests and patients or family members are likely to report problems.
In contrast, with antipsychotics the normal, expected side effects can be life threatening and require lifestyle changes from day one. The *adverse* side effects can be very difficult to spot, the patient is unaware of them, and they are irreversible. Monthly face-to-face monitoring is important. There are not many drugs in any class where this is the necessary. Usually, you stop the drug and the side effect stops. Not so with antipsychotics. The effects, once they start, are permanent. They are also very common and with extended use, nearly universal. These patients require careful monitoring.
Advertising these drugs to people who are most likely to request them from someone other than a psychiatrist is unethical, at best. That is not the case with anti-cancer drugs or biologics used to treat autoimmune disorders. Those patients receive care from specialists, but most people with depression do not.
I have no formal education in pharmacy. But I had a liberal arts bachelor’s degree before I was diagnosed with a major psychiatric disorder 30 years ago. So I learned. Being educated about psychiatric drugs is essential for managing my life. Most psychiatric patients do not have the privilege of higher education because of how and when the disorders occur. Most of us with severe mental illness have limited employment options, if any. We have limited social lives. Discrimination is normal. This makes those ads insulting, and predatory, as well as unethical.
The key paragraph here is “does this have teeth.” This administration is all about optics and sound bites, with little regard for crafting actual laws and policies; so far RFK Jr hasn’t demonstrated even a basic understanding of his job, and he’s fired all of the people with real knowledge, skills and experience. So I think this is a big “nothing burger.”
Yup. Speak loudly and carry a fake stick, to paraphrase Teddy Roosevelt.
As a retired pharmacist with an advanced degree, I have long been opposed to direct to consumer advertising for medications, for all of the reasons discussed in the post, and from personal experience “counter educating” what a patient “learned” by a google search or an ad.
I am one of those (probably rare) people who asked for the drug insert in addition to the patient information. Unfortunately, they are frequently not available any more. Digging through online trash has gotten harder because there is so much more of it. Thankfully I have an older, well seasoned pharmacist who can answer questions and provide insight. (I will never talk politics with him though!!)
One positive aspect of many current drug ads: they feature great musical numbers with a bevy of dancers who all look like they could use the exercise. We need more of that!
Another reason Big Pharma is immune from any real curbs on their advertising, which could eat into their profits: pretty much everybody's retirement portfolio has substantial stock holdings in Big Pharma.
No one wants that particular golden goose to stop laying eggs - including, in all candor...me.
Unfortunately these pharmaceutical companies activities can serve to bring their essential products (such as vaccines) into disrepute.
That is an excellent point!
Why do I need a prescription from my doctor to get Covid vaccine in Oregon?
Thank you, Ruth
Standard cosplay from people who only care about optics. Talk tough and fund nothing.