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We dive into the controversial world of direct-to-consumer (DTC) advertising with health reporter Martha Rosenberg. Drawing from her extensive knowledge, Martha unpacks how DTC drug ads manipulate consumers, fuel hypochondria, and create demand for obscure medical conditions. We also explore the alarming tactics behind soap product advertisements, revealing how fear-based marketing plays on common insecurities to sell products.
Martha Rosenberg is a health reporter and the author of Big Food, Big Pharma, Big Lies and Born With a Junk Food Deficiency.
She discusses the KevinMD article, “How drug and soap commercials are manipulating you.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today we welcome Martha Rosenberg. She’s a health reporter, and she’s the author of the book Big Food, Big Pharma, Big Lies. We’re talking about the KevinMD article “How drug and soap commercials are manipulating you.” Martha, welcome to the show.
Martha Rosenberg: Thank you, Dr. Pho. I’m so happy to meet you after all this time.
Kevin Pho: And thank you. I’m always interested in hearing your perspective. You’ve always written great pieces on KevinMD, and we’re going to talk about one of those today. But before we do, just briefly share your story and journey to my audience.
Martha Rosenberg: I surely will. So basically, my background is advertising, and that’s why I’m so critical of ads, especially on TV. However, I also studied, in medical school, pharmacology, so I’m very well informed on pharmacology.
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Kevin Pho: Today’s article, we’re going to talk about “How drug and soap commercials are manipulating you.” Before talking about the article itself, tell us what led you to write it in the first place.
Martha Rosenberg: OK, well, I listen a lot to radio and TV. They used to call the press, which I’m a member of the press, I’m a reporter, the fourth estate. But I really believe drugmakers and Big Pharma have become the fourth estate. They have so dominated the news waves. That’s why I wrote my article for you, my recent article for you about drug and soap. Every single ad is either for fragrance beads, which I wrote about, and, of course, medication.
Kevin Pho: All right. And tell us about the article itself, for those who didn’t get a chance to read it.
Martha Rosenberg: Well, I’m talking about how I’m offended as a former creative director at McCann Erickson, which is a big ad agency. I’m offended by the manipulation of these ads. I believe that I’m against direct-to-consumer advertising in general, and what I’m seeing happening is they’re spreading hypochondria. They’re telling people who feel fine that they have a disease.
They take diseases, and they give them snappy little initials like EPI or COPD, or even ED is a snappy initial to sell the disease. But even worse, Dr. Pho, is what we call in advertising the unbranded disease advertising, where they’ll talk about a disease that you might have, and they don’t tell you that they have a drug to treat it. To me, it just spreads hypochondria.
Kevin Pho: So you’ve been on the advertising side. Just give us some insight. What is it like on the advertising side when it comes to creating a campaign for a disease, a drug, a soap product? What’s some of the thought process that goes on on the advertising side?
Martha Rosenberg: Well, that’s a great question, Dr. Pho. When I was in advertising, we didn’t have DTC yet, direct-to-consumer. But generally speaking, we want a relationship between the viewer or listener and the product. And so there’s a lot of use of the word “you.” And back when I was in advertising, we’d say, “Is your beer working for you? Is your antihistamine working for you?” And the idea would be that you have a relationship with a product.
And I worked for an ad agency fairly recently marketing a diabetes drug. I was asked to change the copy. I won’t go into details, but I asked my supervisor, “Why are we changing the copy?” To enlarge, to embrace more patients. And she said, “We make more money.”
Well, obviously, the ad industry, of course, we’re out to make money. But the idea would be to establish a relationship between the listener and the product, and also, in the case of DTC, to scare. There’s so many examples where “You may feel fine, but you may be suffering from.” I mean, that offends me as a viewer, as a human being, as somebody who tries to stay healthy and doesn’t want to keep running to a doctor saying, “Oh, I might have this. I might have this symptom.”
Kevin Pho: So you alluded to this earlier, but let’s drill down and go in more detail. Tell us some about the specific psychological tactics that a lot of these drug and soap commercials that you see on television, direct-to-consumer advertising, what are some of the most common psychological tactics that they use?
Martha Rosenberg: Well, OK. First of all, online, there’s what they call symptom checkers, which means if you have any doubt that you need these drugs, you’re suffering from this disease, you go online and it says, “Do you have a cough? Do you have trouble sleeping at night?” So there’s symptom checkers.
And secondly, a really obtuse area of advertising that follows when I was in advertising is the list of side effects. And you would think that the list of side effects, like death, brain bleeds, epileptic seizures, you’d think it would unsell the drug. But what my research tells me is it produces a hypnotic state where the drug actually sells better.
Some things I read is that if the medication might cause irritation at the injection site, because they seem to always be biologics, that is what the viewer might remember versus, let’s say, lowered immune system or something like that. So the side effects are very much a part of the sell. They make viewers kind of in a hypnotic state. The scary side effects are overridden by the more minor side effects.
And mostly, I have to say this, Dr. Pho: People enjoy DTC ads because they’re high-budget. They show the shuffleboard, the fat people going like this, the singing. They’re very manipulative. I know; I made TV commercials.
Kevin Pho: So you’re saying that specifically with the side effects, because that sometimes can last ten to fifteen seconds of a thirty-minute commercial, it produces a hypnotic effect? And is data showing that not only does it minimize major side effects, it actually helps sell the drug? There’s data behind that?
Martha Rosenberg: There is. There are certain researchers who’ve exposed that, and I believe I’ve written that on your own websites. I’ve written about that on your platforms because it’s insidious. It works.
I mean, I’ve gone to medical conferences where physicians actually have to enroll in refusal skills because patients will come in with a coupon, and they’ll say, “Well, I have this disease. I know it because I saw it on TV, and I need this drug.” And so it very much sells the disease. And I believe it’s an insult, not just to patients or potential patients, but to physicians.
Kevin Pho: So let’s talk about that. How do you think that the influx of direct-to-consumer drug ads, how’s that affecting the doctor-patient relationship?
Martha Rosenberg: Well, it’s taken diagnosis and treatment out of the office and put it on the general airwaves. Everybody’s an expert. I think it’s insidious as heck, and I know that we’re never going to see the end of it because it works. Drugmakers and what we call Big Pharma have really been able to lose their drug reps and just rely on DTC. So they love it.
But frankly, websites, and especially news sites, love it too. That’s their main revenue. You will never, ever see it go away. It is like the ultimate advertising gold mine right now, the DTC advertising.
One thing that I get so mad at, Dr. Pho, is what the drugs are. These are all biologics, which means they’re injected, right? They’re all what we call large-molecule monoclonal antibodies, cheap for the drugmakers to make, very resistant to generic competition. Almost all of them lower the immune system and invite other diseases. They’re terrible drugs. They take a very minor side effect or minor condition and give you an immune-reducing drug. So I’m very against. They’re very, very expensive.
And they’re obviously a gold mine right now for drugmakers, which is why we see so many of them. But what we have, I’ve joked about this even on your platform, is we have a whole group of people now, Americans especially, injecting themselves with drugs. I mean, what the heck? For eczema. I’m not saying eczema doesn’t exist. But some of these conditions are so overmarketed to sell drugs.
Kevin Pho: So in terms of the effectiveness of direct-to-consumer advertising, you said they clearly work or else companies won’t do it. Any ballpark figures in terms of how much revenue it pushes, how persuasive they are? What kind of studies or data can you cite, perhaps off the top of your head, that shows how effective they are?
Martha Rosenberg: Well, at my fingertips, I don’t have anything. But I have written in the past about a huge increase in how many adults report taking four or more drugs every month. In other words, DTC has increased the number of chronic drug-taking adults. And I think that’s a way to measure it.
And another thing we haven’t even talked about yet, Dr. Pho, is the kids. Don’t get me started on the kids and all the drugs. Your child, he’s eight or he’s six and he runs around. He doesn’t have ADHD.
Kevin Pho: So let me actually get you started on the kids. Tell me about how kids could be a potential target for the drugmaker.
Martha Rosenberg: OK, well, I had one. I’m a cartoonist, and this is the book I really wish people would look at on Amazon. I won a news award for a cartoon where the little kids were asking their mom, “Can we take the purple pill?”
Kids are, I was too, we’re very affected by advertising. And I personally believe children are very overmedicated. These younger generations, I’m not so young anymore, don’t tell them they’re depressed. Tell them they’re growing up.
In this article that we’re talking about on your platform, I talk about the add-on phenomenon. And you see this in medicine a lot, medical advertising, where they’ve told you you have depression. Maybe you just have life. Maybe you have a bad job. Maybe you have a bad marriage. But they’ve told you you have depression.
Your antidepressant, probably an SSRI, is not working. Instead of not taking it and saying, “Maybe I need to join a gym,” they say, “Add this drug on.” So there’s a lot of this add-on phenomenon, especially with children. If your little son is on an ADHD drug and he’s still a little boy, this doesn’t mean you add another drug on there. And so I’m really offended by the way the population is being manipulated.
Kevin Pho: And when it comes to direct-to-consumer drug advertising, the United States is relatively unique in that phenomenon. There are only a handful of countries that even allow this. Is that correct?
Martha Rosenberg: My understanding is only New Zealand and us. And there’s reasons for that. Advertising works. I did it for years. I mean, it works. I had an ad once for some orthopedic practice that was going to treat sports injuries a while ago, and I had runners say to me, “As soon as I heard your ad, I went to the doctor for a sore leg.” I mean, advertising works.
Kevin Pho: And to your knowledge, has there been any serious effort to curb direct-to-consumer advertising, or is the pharmaceutical lobby just too powerful?
Martha Rosenberg: The AMA has come out against it, and then they kind of revised that because it’s financially driven. You’re not going to get rid of it. But they said that maybe new drugs should not be advertised because the new ones are, we’re the guinea pigs, so we don’t know.
Don’t get me started, doctor, about SSRIs, because I’ve known people who’ve had very bad effects from them. But they were marketed so prodigiously when they came out that nobody had yet seen their calcium effects and the production of fractures. I know so many people who’ve been on these for ten, twenty years, and their ankles and their wrists are fracturing. Your SSRI, if you want to take one, don’t stay on it twenty years.
And so I guess what I’m saying is some of the side effects, they follow the marketing. But in answer to your question, no. Only New Zealand, and I don’t know why, I’ve not been there, I’d like to go there, allows it. We’re very commercially driven.
Another thing we could talk about at some point would be all the celebrities that hawk drugs for Big Pharma once they’re not asked to be in a movie anymore. So they’re like, “Oh, this is a great drug.” And I’m just offended as an ad woman, as a consumer, as a human being who tries to stay healthy and tries to stay off drugs.
Kevin Pho: And when it comes to health-related products, it’s not only drugs. You also talk about things like laundry detergents as well. There’s a lot of manipulation when it comes to something as simple as laundry detergents, right?
Martha Rosenberg: Well, you’re absolutely right, and I thank you for bringing that up. I noticed that the last couple months there’s just been a deluge of fragrance ads. Your laundry detergent could smell better, or your whole body smells, not just your armpits. And this whole thing is driven by what we call Big Chem.
And the reason I’m offended by it on many levels, one reason is that there was a move against fragrance in personal products because they’re highly correlated with endocrine-disrupting chemicals and even cancer. So they’re not safe. There was a while where a sell line would be “fragrance-free.”
So I’m very offended. They’ve recently, I don’t know if you watch TV, but unfortunately it’s on quite a bit here, they actually have ads now where they say, “Your whole body smells.” And then they say, “No matter how many times you wash your clothes, they still smell.” What is this all about? I mean, this is as bad as drug advertising. And it’s to sell you fragrance beads that probably stay in the environment for years and certainly are endocrine disruptors.
And so there’s a whole movement. Years ago, they really pushed Tide and Gain and soaps, and that’s why many shows are called soap operas. They were literally supported by soap advertising, and it’s almost like this has come back.
And another thing that I find offensive, maybe I’m wrong, but I feel they’re racist. They always show people of color with these ads about “You stink.” It just offends me. It offends me that we don’t stink. And for Big Chem, that’s like drug advertising in the sense that it sells self-doubt.
Kevin Pho: So what are some of the answers that you have here? What are the role of some of the regulatory agencies?
Martha Rosenberg: Well, I’m not real hopeful about FDA. I think there’s a lot of really nice websites out there and Substacks that report on this. But I’m certainly not the only one that talks about this. There’s a lot of sites that you could subscribe to them or patronize their advertisers and avoid these types of advertising. So there’s online ways around it, and there’s many reporters talking about this.
Kevin Pho: Reflecting on your time in the advertising industry, do you think that there is an ethical way to advertise drug and health products without exploiting consumer fears or manipulating their behaviors?
Martha Rosenberg: Wow, no, I don’t think so. I think the very act of advertising a drug is inherently wrong. It’s inherently wrong. That’s why we’re the only country except New Zealand that doesn’t.
Kevin Pho: We’re talking to Martha Rosenberg. She’s a health reporter. She’s the author of the book Big Food, Big Pharma, Big Lies. Today’s KevinMD article is “How drug and soap commercials are manipulating you.” Martha, we’ll end with some of your take-home messages to the KevinMD audience.
Martha Rosenberg: OK, well, I’d like to say I did a lot of research for this book, and I looked at old ads before DTC consumer advertising was legal. And I put in my book a lot of old ads from the journals, and you can see they’re very anti-patient. They couldn’t run today. They’re misogynistic; they’re this and that. But I also put twenty-seven cartoons in here because, let’s face it, it’s not a happy topic, and so we need to laugh a little bit.
But the take-home message, I would say, I recommend one website that I really like. It’s called Ask a Patient, and all you do is you go and you can post your experiences with the medication. There’s no filtering. There’s no advertisers. I love that site.
I also love Public Citizen, which is a great consumer. I would say to viewers, pursue the consumer sites because it’s a consumer issue.
Kevin Pho: Martha, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Martha Rosenberg: Well, thank you, and good luck in everything you keep doing. I love how you showcase so many different voices. Thank you.
Kevin Pho: Thank you so much.
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