The scary evolution of direct-to-consumer advertising

One night in 1997, as Americans watched Touched by an Angel they were touched by something else unexpected: an ad for a prescription allergy pill called Claritin, sold directly to patients.

Prescription drugs had never been sold directly to the public before — a marketing tactic called direct-to-consumer or DTC advertising. How could average people, who certainly had not been to medical school, know if the medication was appropriate or safe without a doctor’s recommendation?

Soon, ads for Meridia, Propecia, Singulair, Paxil, Prozac, Vioxx, Lipitor, and Viagra followed — exhorting patients to “ask their doctor” if the drug was right for them. By 2006, Pharma was spending $5.5 billion a year on the ads and was becoming the Wall Street darling it is today.

But a strange thing happened when Americans viewed all the pill ads. People discovered they weren’t as healthy as they had believed. Pretty quickly, they developed seasonal allergies, social anxiety, high cholesterol, depression, bipolar disorder, restless legs, GERD and worse.

Theoretically, the newly available medical information created a better-informed patient. Except for three things. Diseases were overplayed to sell drugs. (Gastroesophageal reflux disease, or GERD, was almost unknown but after DTC advertising, Nexium, which treated it, became the nation’s fourth-bestselling drug.)

Risks of diseases like heart disease or thinning bones were played up to scare people into taking drugs. And finally, expensive and dangerous drugs were pushed when milder, cheaper ones would do. The best example is Vioxx, billed as a “super-aspirin” for everyday arthritic or menstrual pain but ending up causing 27,000 heart attacks and sudden cardiac deaths.

The successful mode of advertising not only turned people into hypochondriacs, it turned doctors into order takers simply complying with patient demands. Medicine literally degenerated into “hey Doc I saw on TV …”

And it gets worse. DTC advertising has been so successful, radiation is now advertised on TV and radio — specifically proton therapy. If patients know what kind of pills to take — why not the kind of radiation to treat their cancers seems to be the thinking.

Because a proton center costs $152 million to build and operate, it creates powerful incentives to advertise—literally to pay for the machine. But is it better? Not necessarily. According to comparative effectiveness studies in the Journal of the American Medical Association (JAMA), patients on intensity-modulated radiation therapy (IMRT therapy), a less expensive treatment, had a 34 percent lower risk of gastrointestinal side effects compared to proton therapy. (IMRT, the cheaper therapy, was also associated with 22 percent fewer hip fractures and a 19 percent reduced need for further cancer treatment than traditional radiation though there was a greater risk of erectile dysfunction.)

How much more does proton therapy cost? Often twice as much as IMRT and the costs is usually borne by the taxpayer through programs like Medicare.

Like drug ads, “Ask Your Doctor” radiation ads selling proton therapy use marketing to subvert good medical practice, triangulating the doctor in a marketing scheme. If proton therapy were really superior, wouldn’t doctors know it without ads directly targeting their patients?

Martha Rosenberg is a health reporter and the author of Born With a Junk Food Deficiency.  This article originally appeared in

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