Harvard Health Ad Watch: How direct-to-consumer ads hook us

If you’re like most people, you’ve seen a ton of direct-to-consumer (DTC) drug ads in recent years. They’re all over television, in magazines, online, on billboards, and slapped on the sides of buses, promoting treatments for arthritis, cancer, heartburn, psoriasis, flagging memory — and more. The deluge of drug ads can be overwhelming. Worse, the information is often incomplete, biased, or confusing.

We launched the Harvard Health Ad Watch series to highlight some benefits and problems with health product advertisements. We’ll focus on the evidence behind the ads and show you how — and why — to view them with a skeptical eye.

This post briefly explains direct-to-consumer advertising and FDA regulation, as well as rationales and potential drawbacks for these ads. It also alerts you to words to consider very carefully when advertisers clamor for your attention. In other posts, I’ll analyze some popular health product ads.

How common are DTC ads for health products?

Almost every country in the world bans DTC ads for health products like medications and procedures. Years ago in the US, drug ads were directed primarily at doctors. But in 1997 the FDA eased restrictions to allow pharmaceutical companies to advertise directly to consumers. With restraints lifted, spending on prescription drug ads soared to nearly $10 billion a year, and is rising.

Do the ads work well for drug companies? Yes, indeed! If these ads didn’t work, drug companies would never spend so much on them. Do they actually improve patient health? That’s far less clear.

The FDA has a limited role in DTC advertising

FDA regulations require that advertising be accurate, and promote only approved drugs for approved conditions (called indications). Additionally, ads must state medication risks and ways to get more information. The FDA’s goal is to assure prescription drug information is "truthful, balanced, and accurately communicated" — a lofty aim that receives mixed reviews.

The rationale for DTC ads

Advocates often present the ads as a chance to

• educate people about conditions and treatments they were unaware of
• improve health by encouraging people to take medications they should be taking
• raise awareness of possible side effects, because regulations require consumers to be referred to a website, magazine, or other source for more information
• lessen stigma surrounding certain conditions, such as mental illness or erectile dysfunction
• increase detection of unrelated diseases if patients are inspired by DTC ads to see their doctors.

Potential drawbacks to DTC ads

Unfortunately, experience shows that some DTC ads may

• present incomplete or biased information
• spur people to ask for medications they don’t need
• promote medications before long-term safety is known. In one case, a new pain relief drug was pulled from the market due to an unexpected rise in heart attacks and strokes — but not before millions of people saw the ad and began taking it.
• create conflicts between patients asking for a drug and doctors who don’t recommend it
• drive up healthcare costs without adding health benefits (new drugs are much more expensive than generic drugs that may do the same job, yet cost is rarely mentioned in the ads).

Advertising words to consider very carefully

Keep this in mind: the main purpose of DTC drug advertising is to sell a product, not educate consumers. The language of drug ads makes that clear. Consider these common examples.

• "A leading treatment for this condition." Perhaps, but what if there are only two or three drugs available for that condition? When considering any treatment, it’s important to know what the other options are and how they compare, yet it’s unlikely this additional information will be mentioned.
• "No other treatment has been proven better." This suggests that the advertised drug is great. Yet it might be only as good as — and no better than — older, less expensive, or even over-the-counter competitors. Plus, drug ads are unlikely to mention the option of taking nothing for the condition in question, even though many minor ailments get better on their own.
• "In clinical studies, this medication proved more effective than standard treatment." So, how good is standard treatment? If a drug helps only 20% of people with a disease and "standard treatment" helps 15%, the added cost and risk of side effects of the new therapy may not prove worthwhile.
• "I don’t care about studies… it works for me" or "This drug gave me my life back." The power of the anecdote — one person’s story of near-miraculous improvement with a particular treatment — is undeniable. The problem is that studies do matter. Otherwise, we’d all be taking the advice of a proverbial "snake oil salesman" recommending unproven and potentially dangerous drugs because someone said it worked for them. And, of course, in ads promoting drugs or procedures, that "someone" is often a paid actor or spokesperson.
• "For some, one pill is all you need for 24-hour relief." This sounds good, but how many is "some"? If one in 100 get 24-hour relief, the drug may be less effective than the ad suggests. Also, what does "relief" mean? If a drug reduces pain by 10% for 24 hours, that’s a rather modest benefit; a competitor’s drug might reduce it by 80% or even 100%. These details are often left out of drug ads.

The bottom line

As an arthritis specialist, I’ve found that patients who ask me about drug ads are often surprised to hear about important information the ads left out. For example, most of the newest and most effective drugs for rheumatoid arthritis are given by injection under the skin or into a vein, yet many ads for these drugs never mention this!

Also, I think DTC drug advertising has had unexpected costs: these ads tend to "medicalize" everyday aches, pains, and other symptoms while calling for prompt treatment with their medication. For some people, this constant barrage may be terrifying or anxiety-inducing, as if just around the corner there lurks a new deadly or debilitating condition you should hurry to investigate with your doctor.

So, be wary. Even if information in a drug ad can be considered accurate, it may not be thorough, balanced, or unbiased. In the end, it’s another instance of buyer beware. Stay tuned.