Download Snake Oil: Direct-to Consumer Advertising

Selling Snake Oil: Direct-to
Consumer Advertising
James G. Anderson, Ph.D.
Purdue University
Ask Your Doctor!
One evening on CBS News
Condition
Drug
Restless Leg Syndrome
Requip
Heartburn
(Acid Reflux Disease)
Zantac
Allergies
Nasonex
Hemorrhoids
Preparation H
Pain
Advil
Sleeplessness
Ambien
Allergies
Benadryl
Back Pain
Thermacare
Medicalization
 Defining a problem as a medical illness
or a disorder requiring medical
intervention to treat it.
Expansion of Medical Jurisdiction
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Child birth
Menopause
Sexual Dysfunction
Anxiety
Childhood Behavior
Heartburn or Indigestion
Post Traumatic Stress Disorder
Obesity
Hair Loss
Short Stature
Engines of Medicalization
 Medical Profession
 Special Interest Groups
 Commercial and Market Interests
The Pharmaceutical Industry
 Passage of the Food and Drug Modernization
Act 1997 allows for a wider usage and
promotion of off-label uses of drugs and
facilitated direct-to-consumer advertising
 Spending on direct-to-consumer advertising
increased from $1.1 billion in 1997 to $4.5
billion in 2006.
 The FDA sent only 15 warning letters to drug
companies regarding ads in 2005 and 22 in
2006.
Sexual Dysfunction
 In March 1998 the FDA approved Viagra
as a treatment for erectile dysfunction
(ED). “Ask your doctor if Viagra is right
for you.”
 Sales were sensational! The first year 3
million men were treated with Viagra
translating into $1.5 billion in sales. By
2003, 6 million men were taking Viagra
and sales rose to $1.7 billion
Sexual Dysfunction
 With the introduction of Levitra and Cialis
the drug industry estimates the potential
market for these drugs to be 30 million
men in the U.S. alone.
 The drug industry has expanded the
notion of ED and has begun to
encourage the use of these drugs as an
enhancement to sexual pleasure and
relationships.
Anxiety
 Prozac was introduced in 1987 as an
antidepressant. Paxil was approved by the FDA
in 1996 to treat “Social Anxiety Disorder (SAD)”
and “Generalized Anxiety Disorder (GAD)”
 Marketing diseases and then selling drugs to
treat them is now common. The tag line is
“Imagine being Allergic to People.”
 Paxil is now the prescription drug that is
number six in sales amounting to $2.1 billion in
2001.
Children’s Behavior Problems
 Children’s problems constitute a growing
market for psychotropic drugs.
 Ritalin in particular is being prescribed to treat
attention deficit hyperactivity disorder (ADHD).
 Spending on behavior drugs for children and
adolescents rose 77% from 2000 to 2003.
 These drugs are now the fastest growing type
of medication taken by children eclipsing
aqntibiotics and asthma treatment.
Short Stature
 Synthetic human growth hormone became
available in 1985 to treat a rare hormonal
disorder.
 Genentech began to market the off-label use of
their drug, Protropin, for children who were
short but had no growth hormone deficiency.
 This market has grown since the FDA approved
the use of Eli Lilly’s drug, Humatrope, for use
with short-statured children in the lowest 1.2%
of the population.
The Future
 A private market for enhancements for
children exists.
 Biotechnology companies will work to
increase the size of this market.
 The promotion and use of biomedical
enhancements will increase
medicalization of human problems.
The New Drug Epidemic
 2.1 million teenagers are abusing
prescription drugs that they obtain from
other teens and adults (e.g., Adderall,
Ritalin, Oxicontin)
The Human Body
 Cosmetic surgery from tummy tucks to
liposuction to nose jobs to breast augmentation
have become big medical business.
 Between 1960 and 1990 there were 2 million
women who received silicone breast implants.
In 2003 alone, 280,401 breast augmentations
were performed in the U.S.
 Overall 8.3 million Americans had cosmetic
medical procedures in 2003, a 20% increase
from the previous year and a 277% increase
since 1997.
Tummy Tuck
Price List
Surgery
With Airfare
Without Airfare
Breast
Augmentation
$5,000-4,500
$4,500-4,000
Breast Reduction
$4,750
$4,250
Liposuction
(3 area)
$4,500
$4,000
Tummy Tuck
$5,500
$5,000
Blepharoplasty
$3,800
$3,300
Nose Surgery
$4,500
$4,000
Obesity
 The number of gastric bypass surgeries
in the U.S. has risen from 20,000 in 1965
to a projected 144,000 in 2004.
 Bypass operations are becoming an
increasingly common way to treat
problems of overweight. The recent
Medicare policy shift declaring obesity as
a disease will further expand the number
of procedures performed.
Lapband
Hawking other Health Products
caveat emptor!
 Diet products
 Herbal products
 Hearing Aids
 Wheel chairs
Power Chair Jazzy 1170
Arguments for DTC
Advertising
 DTCA serves an important physician and
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patient education function that raises their
awareness of new conditions leading to greater
detection, diagnosis, and treatment
Patients are empowered to seek the best
available treatment for their conditions
In some instances, the patient may be better
informed than their physician
DTCA stimulates the patient to discuss their
condition and treatment with their physician
DTCA is free speech and is protected by the
U.S. Constitution
Arguments for DTC
Advertising
 DTCA stimulates the patient to discuss
their condition and treatment with their
physician
 DTCA is free speech and is protected by
the U.S. Constitution
Arguments against DTC
Advertising
 DTCA raises health care costs by stimulating
consumers to demand more expensive new
drugs and products (e.g.. Celebrex at $188/mo.
vs. ibuprofen at $18/mo.)
 Pressure from patients erodes physicians’
authority and may lead to inappropriate
prescribing
 Ads may be misleading and promote
inappropriate use. Education should not be left
primarily to private companies promoting their
products.
Arguments against DTC
Advertising
 The FDA should require a waiting period of two
years from the time a drug is approved until the
drug can be promoted throuugh DTCA
 Advertising leads to early heavy use of new
drugs before their long term safety has been
ascertained (e.g., VIOXX,HRT)
 Among the 10 drugs most heavily
advertised to consumers, many are
deemed less essential medications by the
WHO.
Concerns
 Pharmaceutical and biotechnology companies
are having an increasing impact on what is
considered normal or pathological. This is
worrisome since these companies are primarily
responsible to their shareholders and not to
their patients. Shareholder desires are
frequently at odds with patients' needs.
 The U.S. health care system has been
reshaped from an enterprise focused on the
health of the people to just another market
place like fast food prducts, automobiles, etc.
Engines that Drive Medicalization
 Biotechnology
 Consumers
 Managed Care