Views » December 20, 2007

Warning: Drug Ads Can Make You Sick

A $4.2 billion annual drug industry incessantly reinforces the medicalization of complaints through direct-to-consumer (DTC) advertising

By Terry J. Allen

Jane’s family is suffering from plagues of biblical-lite proportions. Her teenage son is unruly and easily distracted. Her daughter has menstrual cramps, is 12 pounds overweight and shy. Her husband sleeps fitfully and has occasional heartburn and irregularity—not to mention that his libido is falling and his cholesterol rising. As for Jane, her menopause generates more heat than a blowtorch. Her knees twinge, her breasts are less perky and her jaw line more blurred. Her personality is flat and her legs restless. All of them are less happy than they think they should be.

Although there is a diagnosis, pill or surgical treatment for each of their ills, the family members could simply be suffering from exposure to advertising that sells a fantasy of flawless health, perfect skin, clockwork bowels, extended youth and perpetual cheerfulness in the face of disappointment, aging, money woes and the reign of George Bush. They may, in fact, be healthy people snookered by the pharmaceutical industry, the media and their doctors into believing that ordinary frailties are diseases; that the human condition can be cured.

A $4.2 billion annual industry incessantly reinforces this medicalization of complaints through direct-to-consumer (DTC) advertising.

In 1998, the Food and Drug Administration (FDA) decided to allow pharmaceutical companies to hawk prescription drugs to the public, with limited oversight and minimal explanation of safety and side effects. A 2006 Government Accountability Office investigation found some of these marketing efforts “false and misleading” and faulted the FDA—which is responsible for oversight—for failing to maintain standards of accuracy and to protect the public. The United States and New Zealand are the only countries that allow DTC marketing.

Big Pharma says that the goal of DTC ads is to educate the public about what treatments are available. But there is no denying that the images of people caressed by soporific green moths, charmed by Latino bees and enticed by sexually fulfilled couples can create expectations and perceived needs that lead to unnecessary and expensive drug consumption. Some of the products are only minimally effective. Many can cause liver or kidney damage, high blood pressure or other adverse effects that would have to be countered with still more drugs—each with its own side effects and risky interactions.

One undeniable side effect of DTCs is increased sales and profits for drug manufacturers. “Every $1 the pharmaceutical industry spent on DTC advertising in 2000 yielded an additional $4.20 in drug sales,” the Kaiser Family Foundation recently reported. Indeed, direct-to-consumer advertising “was responsible for 12 percent of the increase in prescription drugs sales, or an additional $2.6 billion.”

Many doctors act as enablers. A majority of them reported that DTC ads caused patients to “confuse relative risks and benefits” or to believe the drugs “worked better than they do,” according to the FDA. Almost three out of four docs said patients were spurred by the ads to ask for unnecessary prescriptions and to expect a prescription for every condition. Nonetheless, despite feeling pressured and sometimes ambivalent about efficacy, safety and appropriateness, doctors turned down requests for a brand-name prescription only 2 percent of the time, the FDA found.

Americans are swallowing a lot of pills. Spending on prescription drugs is America’s most rapidly increasing healthcare cost and, in 2004, outpatient prescription medications—3 billion scripts worth $200 billion a year—constituted nearly 20 percent of healthcare spending, according to a government survey. Almost half of us take at least one prescription medicine, and one in six downs three or more medications, according to a 2004 Department of Health and Human Services report.

There is something in the American character that loves a quick technological fix, and DTC advertising convinces us that drugs can cure our physical and psychological aches and pains—even our existential crises and obnoxious personality traits. While many people with debilitating depression do find better living through chemistry, there may be something wrong with a definition of normality that classifies one in 10 women, 18 years of age and older, as so clinically depressed that she requires powerful antidepressants. Or a definition of normality that diagnoses 15 percent of 16-year-old boys with attention deficit hyper-activity disorder (ADHD). ADHD drugs make up three of the top five drugs for children age 17 and younger (sales totaling $1.3 billion in 2004). And of the 4.4 million 4- to 17-year-olds with an ADHD diagnosis, more than half were medicated despite what the Centers for Disease Control and Prevention called “substantial health risks.”

The old joke used to be this: A doctor who finds a patient healthy hasn’t looked hard enough. DTC advertising cuts out the middleman and allows the consumer to over-diagnose. It directly exploits the public’s fears and hopes by planting the illusion—and then preying on it—that health, youth and happiness are commodities, and anything less is a disease.

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• Reader Comments

  “Although there is a diagnosis, pill or surgical treatment for each of their ills”

  Or they could just eat right and exercise. But i guess society somehow prohibits this (hmmm, even for people with “white privilege? shocking!). . .

  “enticed by sexually fulfilled couples”

  There is no reason most couples should not be sexually fulfilled. Again, the above prescription *eat right, exercise regularly) could benefit millions (even black folks, perhaps), if only the big drug companies and the government allowed it. . .

  “Or a definition of normality that diagnoses 15 percent of 16-year-old boys with attention deficit hyper-activity disorder (ADHD)”

  Too many parents want the easy way out. Boys by nature are not particularly compliant, but require lots of parental oversight and discipline. It is a tough job, one that too many parents have abdicated.

  Or heck, lets just blame big pharma, advertising and the government (especially if we are black)! After all, then we can watch some tv and crash on the couch.

  Posted by wolf on Dec 20, 2007 at 8:55 PM

  The entire health care system in the United States is a wreck, which is about to become a pile-up of unimaginable proportions as more Boomers inundate the system.  While we should certainly be concerned with prescription drug costs and the highway robbery for which they have a get out of jail free card (because in the Medicare D bill, there is a specific provision that prevents the US Govt., the number one consumer of pharmaceuticals, from adjudicating price controls), the crises in the general availability of health care is perhaps a more pressing issue.  Alas, the day draws near when some unfortunate doctor will be the first to be forced to make an explicit decision regarding the rationing of medical care based upon the most obvious and rational calculation, namely, the potential quality of life, future productivity, and likelyhood of meaningful recovery.  Given this formula, it stands to reason that the critically injured 25 year old with a high likelyhood of recovery assuming that she receives adequate care, say in the ICU, would logically take the bed of a 85 year old patient about whom there is no question that death is imminent. 

  One of the greatest travesties of Big Pharma’s ability to dictate prices and monopolize critical medications, is that some portion of this younger population may very well find itself facing life-threatening situations simply because of its inability to receive preventive treatments.  One aspect of such treatments, of course, may very well be access to cutting edge pharmaceutical innovations, which prove to be prohibitively expensive.  This is not a problem facing only the 45 million uninsured Americans.  The same difficulty is proliferating among the insured population as employers are placing more and more of the burden of insurance upon employees, particularly in the form of skyrocketing deductibility figures.  Frankly, many are no better off with a $1,000 or $500 deductible than the 1 in 7 with no assistance at all.

  Ultimately, it is up to us, you and I, to see that the system is changed.  For the current crisis in health care is nothing more than a symptom of a much more serious, because infinitely more ubiquitous threat: the abject failure of political leadership in this country. And let us not excuse ourselves.  Until the citizens—one wonders if such a concept even remains operative except in the most shallow sense of one who demands rights, without accepting responsibilities—of this country hold our leaders accountable, for the funding of their campaigns, the legislative agendas they pursue, and their failure to uphold their responsibility not to throw us under the bus of monied interests, we are just as guilty as our “leaders.”

  Our television sets, fancy cars, and over mortgaged houses will not assist our efforts in any way whatsoever, neither will our knee-jerk throwing off of the blame for social ills onto illegal “aliens.”  Those who refuse to take the initiative to demand change receive what they deserve, the rest of us have always known anyway that “life simply is not fair.”

  Posted by RBG7 on Dec 26, 2007 at 5:47 PM

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