Intended for healthcare professionals


Direct to consumer drug advertising is billion dollar business in US

BMJ 1999; 319 doi: (Published 25 September 1999) Cite this as: BMJ 1999;319:805
  1. Janice Hopkins Tanne
  1. New York

    Advertising prescription drugs to consumers benefits the public, improves their knowledge of health, and may reduce healthcare costs, Mike Magee, senior medical adviser to Pfizer and a urologist at Jefferson Medical College in Philadelphia, Pennsylvania, argued at a symposium sponsored by the American Medical Writers Association in New York last week.

    But his views were challenged by Susan Hershberg Adelman, a paediatric surgeon at the University of Michigan and a trustee of the American Medical Association, who said that at their best advertisements could inform consumers, advise them on a healthier lifestyle, and send them to see a doctor, but at their worst they could persuade patients to consume drugs without medical supervision.

    People “see advertisements for stimulants, tranquillisers, antidepressants, hypertension drugs, all available from foreign [internet] sites. They self diagnose, order the medication from an internet site, and take it. God only knows what happens to these people,” she said.

    The association called the meeting in response to the vast increase in the United States in the advertising of prescription drugs direct to the consumer over the past few years. It has been estimated that the US pharmaceutical industry now spends more than a billion dollars a year advertising directly to the public.

    Although direct to consumer advertising has been legal in the United States since 1983, it has only become widespread recently, with advertisements appearing on buses, subway trains, in magazines and newspapers, and on television.

    Pfizer, for example, advertises widely in the United States. Full page colour advertisements for Viagra (sildenafil) appear in the New York Times and popular magazines, and some of the advertisements feature well known people, such as the former senator and presidential candidate Bob Dole.

    Dr Magee argued that health costs might be driven down by competition among new drugs; he also believes that awareness of health problems by consumers might lead to early drug treatment and thus an avoidance of later, higher costs for hospitalisation or surgery.

    But the new, expensive drugs are the ones that are usually advertised, Dr Adelman said. When patients are told that there is an older, cheaper drug that is just as effective, they may be disappointed and may even change doctors, believing that their doctor is just trying to keep costs down for the managed care provider.

    In the past, Dr Adelman said, drug companies were protected from adverse drug effects experienced by patients because the doctor was “a learned intermediary” who informed patients of risks and benefits.

    Recently, the Supreme Court of New Jersey ruled that drug companies must make risk-benefit information clearly available in direct to consumer advertising because the “learned intermediary” is no longer there. So far, this ruling applies only in New Jersey.

    Direct to consumer advertising is here to stay, said Wayne Koberstein, editor of Pharmaceutical Executive magazine. He noted the importance of keeping editorial columns independent and separate from advertising.

    “Pharmaceuticals are replacing other treatment modes, such as surgery,” he said. Most pharmaceutical companies are conservative and not accustomed to giving information to the public.

    “I don't see that it's in the interest of pharmaceutical companies to have people take a medication that's wrong for them,” Mr Koberstein said.

    As for advertising prescription drugs to European consumers, he said, “I've spoken to European [chief executive officers of pharmaceutical companies]. They say there are laws against it, but you'd be surprised how much is going on.”

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    A TV commercial for an antihistamine shows a woman windsurfing across a wheatfield


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