Has direct to consumer advertising improved patient care?

An excerpt from Born With a Junk Food Deficiency, (Prometheus Books, 2012). 

Can anyone remember life before Direct-to-Consumer (DTC) advertising with its notorious “Ask Your Doctor” ads? The only thing laypeople knew about prescription drugs came from the ads they peeked at in the Journal of the American Medical Association (JAMA) in the doctor’s waiting room. The ads were full of vaguely ominous terms—nulligravida? hemodialysis?—as well as side effects and overdose treatments that no one understood or wanted to understand.  But one night in 1997, as Americans watched an episode of Touched by an Angel on television, they were touched by something else unexpected: an ad for a prescription allergy pill called Claritin®, promoted directly to the consumer!

Prescription drugs had never been sold directly to the public before, because, without a doctor’s recommendation, how could people know if the medication was appropriate or safe? Soon after Claritin, ads for Xenical®, Meridia®, Propecia®, Paxil®, Prozac®, Vioxx®, Viagra®, Singulair®, Nasonex®, Allegra®, Flonase®, Pravachol®, Zyrtec®, Zocor®, Flovent®, and Lipitor® appeared. And, thanks to the World Wide Web, which appeared at the same time as DTC advertising, the world of diseases and prescription drugs was soon open to anyone who could operate a mouse.

Theoretically, all the newly and readily available medical information created a better-informed patient. It was the same reason the trailblazing feminist book Our Bodies, Ourselves was published decades earlier—patients have the right to know and be participants in their own healthcare. But three features of DTC advertising probably did more harm than good: diseases were created or overplayed, sometimes called disease du jours, to sell drugs. Risks of disease—fears of getting a condition or the condition getting worse—were whipped up to sell drugs. And extreme drugs were marketed when milder and cheaper drugs would do. The best example of this last point is Vioxx, which was billed as a “super-aspirin” for everyday arthritic or menstrual pain but ended up causing 27,000 heart attacks and sudden cardiac deaths before its removal from the market in 2004.

A funny thing happened as Americans viewed all these pill ads. People discovered they weren’t as healthy as they thought. Suddenly, they suffered from seasonal allergies, social anxiety, high cholesterol, depression, bipolar disorder, ADHD, erectile dysfunction, low testosterone, gastroesophageal reflux disease (GERD), irritable bowel syndrome, dry eye, fibromyalgia, chronic fatigue syndrome, seasonal affective disorder (SAD), restless legs syndrome, and worse. In fact, the parade of symptoms and diseases was so all encompassing, comedian Chris Rock said he was ready for a DTC ad asking, “Do you fall asleep at night and wake up in the morning?” “Yeah, I got that!” he joked.

Like consumer-product advertising in general, DTC advertising relied on the time-tested triad of positioning (“the King of Beers”), benefit (“Healthy Choice,” “SnackWell”), and repetition. In fact, the wacky “Can Your Beer Do This?” Miller Lite campaign of the 1990s came back to life to sell the antidepressant Wellbutrin XR®. In a glossy, color magazine ad, a young man rows his girlfriend on a scenic lake and lists the benefits of his Wellbutrin XR. “Can your medicine do all that?” he asks.

When an ad affixes a “your” in front of the noun it is trying to sell—”your mouthwash,” “your pain reliever,” “your engine treatment,” “your teeth whitener”—it implies that if you don’t already have a mouthwash or engine treatment, you should. What does it say about the saturation of psychiatric drugs in the community that “antidepressants” have joined mouthwashes and engine treatments as something people are assumed to have and should have?

Another snappy way to sell a product is to elevate it to an experience. Who remembers ads for the “Kodak Moment,” the “Maalox® Moment,” and even the “L&M® Moment” from years ago? Sure enough, the sleeping pill Lunesta deploys such “experience” advertising with “Lunesta Sleep. Have You Tried It?” in a 2007 Parade magazine ad.

DTC advertising also relies on the product-marketing work- horse of celebrity endorsement. Television personality Joan Lunden and baseball player Mike Piazza pushed the allergy pill Claritin; model Lauren Hutton, hormone replacement therapy; singer Wynonna Judd, the diet drug Alli®; actresses Sally Field and Brooke Shields, Boniva® and Latisse®, respectively; skater Dorothy Hamill and track star Bruce Jenner, the pain pill Vioxx; Sen. Bob Dole, Viagra; and Dr. Robert Jarvik, Lipitor. NASCAR figure Bobby Labonte even endorsed Wellbutrin XL in a print ad in 2004.

But unlike regular advertising in which a celebrity could taint a product with an ethics scandal or jail sentence (like Tiger Woods or Martha Stewart), the opposite occurred: pills were becoming the bad actors, like Vioxx and the highly advertised hormone replacement therapy. In fact, celebrity ads like a ubiquitous Lipitor commercial with Robert Jarvik, MD, the inventor of the Jarvik artificial heart, drove congressional hearings in 2008. “In the ads, Dr. Jarvik appears to be giving medical advice, but apparently, he has never obtained a license to practice or prescribe medicine,” charged John Dingell (D-MI), chairman of the House Committee on Energy and Commerce.

The public liked DTC drug advertising for the same reason it likes corn flakes and laundry detergent ads: the ads are designed to be liked by ad agency writers and artists who are talented enough to be in fine arts or academia, if they weren’t selling Drano® and Turtle Wax®.  And by the late 1990s, whenever a patient and a doctor were alone together, the unseen third party in the room was DTC advertising. Patients came in the office demanding drugs they had self-prescribed for a diseases they had self-diagnosed, and clutching coupons. DTC advertising worked so well, people wanted to have diseases so they could take popular drugs. And, by 2010, some medical schools actually offered “refusal skills” training for doctors to cope with the DTC advertising-emboldened patients.

Martha Rosenberg is a Chicago-based health reporter whose work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune, Los Angeles Times and Consumers Digest.  She is the author of Born With a Junk Food Deficiency.

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