Many people assume TV ads for prescription drugs are for new, cutting-edge medications that represent groundbreaking advances. However, there is growing evidence suggesting otherwise. “People are exposed to a tremendous amount of drug advertising on TV. But it’s highly controversial,” says Neeraj G. Patel, BA, an MD candidate at Yale.
Only two high-income countries (the United States and New Zealand) widely permit this type of advertising for prescription drugs. “Proponents have argued that it improves public health by promoting drugs that are especially helpful or safe,” Patel says.
However, critics counter these ads can be misleading, result in inappropriate prescribing, and inflate healthcare costs. Further, not all drugs are advertised on TV.
Thus, Patel and colleagues wanted to learn more about the characteristics of the drug manufacturers did choose to feature on TV. The researchers analyzed the therapeutic value of the 81 top drugs advertised in direct-to-consumer on TV ads from 2015 to 2021.1 Fewer than one-third of those drugs were rated as carrying high therapeutic value, which Patel and colleagues defined as producing at least moderately better clinical outcomes compared with existing therapies.
During the study period, drug manufacturers spent $22.3 billion on TV ads, with $15.9 billion of that total spent on drugs rated as low therapeutic value. This suggests pharmaceutical companies focus their advertising campaigns on expensive, brand-name drugs that offer little or no comparative benefit vs. existing alternatives. “If you think about it from the pharmaceutical company’s perspective, the main goal is to capture more market share,” says Patel, noting it makes financial sense to advertise drugs with low (or no) comparative clinical benefit. “The high-benefit drugs are probably more likely to ‘sell themselves’ and be recognized by clinicians without all the advertising.”
This raises ethical questions about the public health value that TV drug ads offer. “The U.S. healthcare system allocates billions of dollars annually toward drug advertising, with limited investment in higher-quality forms of medical communication,” Patel observes.
There also are ethical concerns at the individual patient level. Informed consent requires patients to receive sufficient information on the benefits and risks of different treatment options. The problem is that at least for some patients, a significant amount of this information comes from TV ads that selectively promote drugs with limited or no added clinical value. “Patients may be less able to make evenly informed decisions about their care,” Patel cautions.
To counter this, Patel and colleagues urged policymakers to develop evidence-based regulations on prescription drug ads. “This might include requiring disclaimers regarding comparative effectiveness in such advertising, and stronger regulation of misleading elements in these advertisements,” Patel suggests.
Researchers from the Johns Hopkins Bloomberg School of Public Health analyzed drug characteristics and promotional spending for the 150 top-selling branded prescription drugs in 2020.2 They found that higher total drug sales, and a rating of lower added benefit, were linked to a greater proportion of total promotional spending on direct-to-consumer ads. Also, there was significant variation in how much of a drug’s promotional budget was allocated to direct-to-consumer ads vs. promotion targeted to clinicians.
“It raises the question of why manufacturers might think it’s worth more heavily targeting ads to consumers over clinicians. Maybe there are similarly effective, or more effective, treatment options available,” suggests Michael J. DiStefano, PhD, MBE, an assistant scientist in the department of health policy and management and affiliate faculty at the Berman Institute of Bioethics at Johns Hopkins.
Physicians must engage in frank and open conversations with patients about the pros and cons of different treatment options, including drugs that are not advertised. “Patients should realize that the drug ads they see on TV or social media may not provide the full picture of the treatment options,” DiStefano stresses.
Daniel C. McFarland, DO, director of psycho-oncology at the Wilmot Cancer Center at the University of Rochester (NY) Medical Center, says there are two perspectives on direct-to-consumer drug ads. “You can make a favorable case for it by saying they are providing information and helping patients to advocate for themselves,” McFarland says.
Of course, the information often is biased, and not necessarily applicable to the patient’s situation. A patient inquiry about an ad often will prompt a meaningful conversation about the patient’s care. Most patients understand the intent of advertising and trust the physician’s appraisal of the situation. “But there’s another side to direct-to-consumer ads that is an ongoing cautionary tale,” McFarland observes.
Patients asking for drugs by name challenges trust, which is essential for a compassionate patient/physician relationship. It also challenges the fiduciary bond between medical institutions (including physicians) and the patients they treat. “Direct-to-consumer ads lets patients know that actual patient care is only one of several healthcare priorities. It may not even be the top priority,” McFarland explains.
Direct-to-consumer ads remind patients of the complicated financial components to healthcare, all of which detract from the primary goal at hand to some extent. When direct patient care is one of several priorities, patients ask questions that run deeper than what drug to choose. “Patients may question the integrity of the entire system,” McFarland suggests.
Direct-to-consumer ads can create disappointment and frustration for individual patients. Ads suggest straightforward solutions, but the reality is almost always more complicated. “If a new targeted or immunotherapy drug is approved, some people will benefit. Others are not eligible or lack access,” McFarland laments. The underside of direct-to-consumer marketing exacerbates healthcare inequities and challenges the patient’s willingness to trust an apparently for-profit system. “Direct-to-consumer ads push the envelope on the amount of unfairness and divided interest we will accept in our clinicians,” McFarland says.
REFERENCES
1. Patel NG, Hwang TJ, Woloshin S, Kesselheim AS. Therapeutic value of drugs frequently marketed using direct-to-consumer television advertising, 2015 to 2021. JAMA Netw Open 2023;6:e2250991.
2. DiStefano MJ, Markell JM, Doherty CC, et al. Association between drug characteristics and manufacturer spending on direct-to-consumer advertising. JAMA 2023;329:386-392.
Many people assume TV ads for prescription drugs are for new, cutting-edge medications that represent groundbreaking advances. However, there is growing evidence suggesting otherwise.
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