Map of life expectancy at birth from Global Education Project.

Tuesday, August 23, 2005

The Advertising Man

Many people -- okay, somebody -- have implored me to address direct to consumer advertising of drugs. I haven't gotten around to it until now because, believe it or not, the issue strikes me as a bit complicated and I hadn't really settled my thinking about it.

Companies advertise all kinds of stuff that is potentially dangerous, harmful, or worthless, from Hummers to Twinkies to Barry Manilow records. Advertising is mostly about deception -- trying to associate the product with the self image people aspire to, the sexual objects they crave, happiness and fun, peace and beauty. All of this is done by juxtaposition of imagery, not by logic. The actually useful or desirable properties of the product (if any) aren't even mentioned much of the time, but if they are, we obviously don't expect a balanced presentation of advantages and disadvantages. Most important, the vast majority of advertised products are no better than considerably cheaper alternatives. Advertisers are trying to get people to pay more for brand name products, not tell us about products that are unique or better in some way.

All of this is equally true of drug advertising. On the other hand, in order to buy a Hummer, a Twinkie, or Barry Manilow, we don't need permission from an expert. We don't need to go and talk to John Kunstler about the social depravity of driving a military truck to the grocery store and back, we don't need to consult a nutritionist or a music critic. But we can't get Celebrex or Prempro or Prozac without talking to a doctor about it, and the doctor has to write a prescription. At least we have some protection from our folly, in theory. So if we have a problem with DTC advertising of drugs, logically we ought to examine all advertising, much of which is arguably more dangerous than drug advertising. Food can kill, and we did get tobacco advertising off of television but it's still going strong in a lot of other places, while SUVs are degrading the whole planet.

I guess the important difference is that politically, we have a chance to powerfully regulate drug advertising. We could go back to the old regime in which all advertising claims about drugs must be accompanied by the full drug information sheet including all of the adverse effects and counter indications. We could also require advertisers to state why an advertised drug is superior to a cheaper generic alternative, and why it isn't. For example, consumers assumed from watching the ads that Celebrex and Vioxx were more effective than aspirin at releving pain. They aren't.

If we did all that, I would predict that DTC advertising would pretty much stop. However, the real problem is that all of the distortions incorporated in DTC advertising are also present in the drug evaluation and approval process, and in the marketing of drugs to physicians. Undoubtedly, for reasons which are not entirely clear, the Cox-2 and HRT ads did cause physicians to prescribe more of these drugs than they would have otherwise. But I believe that phenomenon would have been minimized if physicians had accurate information and perceptions, and were not themselves being seduced by the drug companies; and if the FDA had been working for us, rather than Merck and Pfizer.

The FDA has now become a bit more diligent about scrutinizing DTC advertising, and the companies' lawyers are also advising them to be more circumspect. But even if the ads are more honest with respect to their literal content, they still use the same sleazy tricks -- happy, healthy looking beautiful people, uplifting imagery, seductive music. So yeah, drug advertising makes me sick, but no more so than advertising in general. It helps to regulate it, but the bottom line is that people need to learn how to think critically and see through all the pink smoke. That's a major priority for society, with all sorts of implications.

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