Harvard Health Ad Watch: A feel-good message about a diabetes drug

This 60-second advertisement for Trulicity, a medication for diabetes, is one of the most feel-good medication commercials I’ve ever seen. The narrator never uses the scare tactic of so many other ads, listing the terrible things that could happen if you don’t take the treatment. Instead, from start to finish, music, images, and spoken words deliver empowering, encouraging messages focused on helping your body to do what it’s supposed to be doing despite having diabetes.

There’s a lot of good information here, but as in most direct-to-consumer health marketing there’s also some that’s missing. Let’s go through it, shall we?

Three actors, three positive messages

The ad opens with uplifting music and statements by three people with type 2 diabetes (though all are actors, as noted in text at the bottom of the screen). A woman faces the camera to declare

"My body is truly powerful."

So far so good! Then a man wearing a hard hat and holding blueprints at a construction site states

"I have the power to lower my blood sugar and A1C."

More good news! By the way, he’s referring to hemoglobin A1C (HbA1C), a molecule in the circulatory system that serves as a standard test of average blood sugar over the previous two to three months. A normal or nearly normal HbA1C suggests good diabetic control, while higher results indicate elevated blood sugar and poorer control of diabetes.

We then meet a third woman wearing scrubs, who works in the physical therapy department of a hospital. She says

"…because I can still make my own insulin and Trulicity activates my body to release it, like it’s supposed to."

Well, that sounds good, too, right? Presented this way, Trulicity seems more natural, because it encourages the release of your body’s insulin rather than relying on injected insulin.

What is Trulicity anyway?

A voiceover tells us Trulicity is not insulin, it’s taken once weekly, and it starts acting from the first dose. Tiny print notes the generic name (dulaglutide) and the fact that it’s an injection "to improve blood sugar in adults with type 2 diabetes when used with diet and exercise." Then we hear who should not take Trulicity, a list including children, people with Type 1 diabetes, and women who are pregnant. Possible side effects are described, such as nausea, low blood sugar, stomach problems, and allergic reactions (see full list here). The FDA requires this in all direct-to-consumer ads.

As the camera pans up to sun shining through leaves and a band plays in the background, we see the physical therapist again — having changed out of scrubs into regular clothes — at a picnic with her family. We hear a few more warnings about side effects and the risk of lowering blood sugar too much when taking Trulicity with other diabetes medications.

Standing in a beautiful park, the woman faces the camera and says

"I have it within me to lower my A1C."

Finally, the voiceover makes the usual suggestion

"Ask your doctor about Trulicity."

What this ad gets right

The description of dulaglutide as a non-insulin medication that stimulates the release of insulin is accurate. The text and spoken information about the medication, including who should and should not take it and the possible side effects, reflect the FDA-approved prescribing information. And the unspoken message — that people with diabetes can be active, working, social individuals — is also true (and, perhaps, underappreciated).

What’s missing from this ad

Some important information provided only in text is easy to miss. It appears only for a few seconds, and some of the print is quite small — they don’t call it fine print for nothing! For example, you could easily miss the fact that Trulicity is available only by injection. Similarly, you could overlook the text explaining that Trulicity is not a first choice for the treatment of type 2 diabetes, and that diet and exercise are important in managing this condition.

Other missing information includes

• the meaning and relevance of HbA1C
• whether Trulicity reduces complications of diabetes, such as kidney disease, nerve damage, or visual problems, or improves quality of life or longevity; in fact, there is evidence it can reduce cardiovascular complications and death in high-risk individuals
• whether Trulicity is better than other treatments for diabetes, including other injectable treatments that work in a similar way, oral medications, or insulin
• the high cost of Trulicity: the "list price" is nearly $10,000/year, although health insurance or assistance programs may lower the out-of-pocket cost.

One other potentially misleading feature of the ad is the choice of actors. Excess weight is a major risk factor for type 2 diabetes. Yet, two of the three actors portraying patients, including the physical therapist who makes multiple appearances, appear close to normal weight. The third appears only modestly overweight.

The bottom line

Advertisements can provide a lot of useful information, but they can also be misleading. While there are regulations around what can and cannot be included in ads for prescription medications like Trulicity, these regulations do not require commercials to paint a full picture.

If you or a loved one has type 2 diabetes, there are better ways to learn about the options for treatment than a drug ad. Yes, talk to your doctor. But don’t limit your conversation to something you heard or read about in a feel-good drug ad.

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