Ask Your Doctor: The Marketing of Drugs

In yesterday’s article, Drug Ads on TV – A Brief History, I laid the blame for the epidemic of exponential growth in pharmaceutical consumption in the U.S. to August 1997, when the FDA allowed drug companies to begin advertising on TV.

The ubiquitous line you always hear in the ads, “Ask your doctor,” is the catchphrase to get you to mention that specific drug to your doctor, so that your doctor may prescribe that specific one, as opposed to a generic variation.

In the above video, Kathleen Slattery-Moschkau, a former pharmaceutical sales rep gives the inside dirt. Slattery-Moschkau, who since leaving the field has gone on to become a filmmaker, making the feature film Side Effects, starring Katherine Heigl as a pharmaceutical sales rep, discusses the billion dollar psycho/pharmaceutical marketing campaign designed to get millions of people on psychotropic drugs through slick drug ads and marketing campaigns that include ghost writing pro-drug articles for medical journals.

Meanwhile, you think advertising on TV is the final resting stop for the drug companies? Think again.

The newest fertile ground is the online marketing of drugs.

There’s been an explosive growth in online advertising: the pharmaceutical industry spent more than $1 billion on Internet ads last year and is projected to spend $1.7 billion on such marketing efforts in 2012.

And with that growth comes the potential for more unscrupulous advertising, because it’s much harder for the FDA to monitor all the websites that drug companies advertise on. Both Eli Lilly and Merck have received warning letters this year from the FDA accusing them of misleading online advertisements, but many more online ads escape the eyes of the FDA.

An increasing number of pharmaceutical firms are now using social media sites such as Facebook, YouTube, Twitter and MySpace, to market their products.

The drug company McNeil developed their own social media site called “ADHD Allies”—aimed at adults with ADHD—and on the site offer an online podcast on financial advice and an ADHD self-assessment tool.

What McNeil and many other drug companies are doing with their online advertising is slick and unscrupulous. The websites don’t mention the company’s product but rather market the disease, under the guise of attempting to share information and educate the public, especially those with the disease.

On these websites, the tone is educational, with the specific disease discussed, but the only options given are pharmaceutical ones. It’s not so easy to tell that a specific drug company is behind the website.

By doing things this way, drug companies can overcome fears of running afoul of FDA regulations that govern drug advertising and at the same time help brand and position their companies in a positive light with both the general public and doctors.

The top 10 drug companies using social media are: Pfizer, Johnson and Johnson, Novartis, Boehringer Ingelheim, AstraZeneca US, Bayer, GlaxoSmithKline, Sanofi-Aventis, Roche, and Merck.

So next time you hear the slogan “Ask Your Doctor,” remember that the slogan is not being used with your best interests in mind.

Drug Ads on TV – A Brief History

I started this series on drugs last week, stating that we are a drugged-out nation, and that when you take medications, it lessens your ability to achieve true health.

I’m not saying to quit taking your medications right now, as that may not be a wise thing to do. What I am saying is that you have to consider what your health goals are, and if it’s becoming healthy, then you have to start becoming proactive in getting off or at least cutting down on your medications.

Pharmaceutical drugs are not the answer to health, but it seems to be that people are being programmed to think they are.

That’s because the drug companies are doing a good job of making people think they are the savior.

A patient of mine recently told me she was on high blood pressure medication. Her blood pressure was 118/80 before she went on medication, and I told her that she does not have high blood pressure and shouldn’t be on a drug for it.

She went to see her doctor, who said that new regulations are stating that her blood pressure puts her in the pre-high blood pressure category, and that it’s now recommended that when people are in that category they should go on blood pressure medication.

I couldn’t believe when she told me this, and I told her that drug companies must have written that regulation, as the only one that serves is them.

She was wise enough to stop the medication, and she’s doing fine.

But how did we get to this point that drugs use is at such an epidemic level?

Blame it on drug ads on TV, which before August 1997 did not exist. It was at that point in time when everything changed. That’s when the FDA allowed it to happen.

Prior to 1997, the FDA rules said, “Advertisements promoting the medical use of prescription drugs must contain a ‘brief summary’ of all important information about the advertised drug, including its side effects, contraindications and effectiveness. In addition, advertisements broadcast over radio, TV or through telephone communications systems must include a ‘major statement’ prominently disclosing all of the major risks associated with the drug.”

Prior to August of 1997, print advertisements for prescription drugs were able to meet the “brief summary” requirement by including the risk-related sections of drug labeling together with the advertising copy. As the drug companies looked wistfully at the enormous marketing potential of television, they saw that there was no way to provide the required information about the drug in 30 second or one minute television ads.

Did Congress act? No, the FDA made the August 1997 rule change quietly and without consulting Congress or really anyone else. Their change allowed the drug companies to “…include information about any major risks, as well as instructions for how consumers can easily obtain more detailed information about the drug’s approved uses and risks.”

FDA Lead Deputy Commissioner Michael J. Friedman, M.D was one of the driving forces behind this change long sought by the drug companies. Dr. Friedman said in 1997, “Today’s action can help promote greater consumer awareness about prescription drugs. By describing realistic standards for television advertising of prescription drugs, we hope to end the uncertainty which has plagued both consumers and industry about the use of this medium. The FDA is committed to making sure that accurate and complete information is available to consumers.”

In the 1997 rule revision, the FDA “…presumes that the broadcast ad is truthful, not misleading, and contains information about the major health risks associated with the drug.

In lieu of providing a “brief summary,” the advertiser would have to provide a mechanism to ensure that consumers can easily obtain full product labeling.” In other words it is enough to quickly list some of the side effects along with a toll-free phone number or web address or advise the listener to speak with a physician.

Shortly after the FDA gave their blessing to the drug companies to advertise on TV, thanks to Dr. Michael Friedman, the good doctor left the agency. In 1998, President Clinton nominated Dr. Jane Henney to be the next commissioner of the FDA, and Dr. Friedman resigned to become a senior vice president at Searle, a subsidiary of Monsanto.

Which begs the question: In whose interests was Dr. Friedman looking after?

The United States and New Zealand are the only two industrial nations that allow the drug companies to advertise on television in this fashion.

As a result of being given the green light to advertise on TV, drug companies have quadrupled expenditures on ads aimed at consumers. Spending on direct-to-consumer advertising increased by 296.4% from 1997 to 2005, from $1 billion to $4 billion.

And the five single drugs with the highest expenditures for direct-to-consumer advertising were Nexium, Lunesta, Vytorin, Crestor, and Advair.

So next time you see an ad on TV, and you hear the famous tagline at the end to “ask your doctor,” remember that drug use in the U.S. has increased exponentially over the last 10 years, thanks in no small part to all that advertising on TV.

The Drugging of Livestock

There are many reasons to consider cutting down or cutting out eating meat. Over the course of this series I’ve talked about the health and environmental ramifications of a meat-based diet.

And of course, cutting down or cutting out meat consumption plays a key role in living a Low Density Lifestyle.

But one of the detrimental health ramifications that I haven’t mentioned to this point is the fact that livestock – chickens, pigs, and cattle – are fed antibiotics on a routine basis. They are fed the drugs not to stop illness but to encourage rapid growth, by promoting weight gain or more efficient feed consumption.

This is a public health nightmare, because the widespread use of antibiotics in livestock can lead to the spread of dangerous bacteria in humans, because it causes the development of bacteria that are immune to many treatments.

70 percent of antibiotics used in the United States is given to healthy chickens, pigs and cattle annually – a total of twenty-five million pounds of antibiotics per year fed to these animals. This is eight times more than the amount used as human medicine.

The FDA reports that 2 million Americans contract bacterial infections during hospital stays annually, and “70 percent of the infections are resistant to at least one antibiotic.”
This is the price that Americans pay for the widespread use of antibiotics in livestock.

With that in mind, in July the Obama administration announced that it would seek to ban many routine uses of antibiotics in farm animals in hopes of reducing the spread of dangerous bacteria in humans.

In written testimony to the House Rules Committee, Dr. Joshua Sharfstein, principal deputy commissioner at the FDA of food and drugs, said feeding antibiotics to healthy chickens, pigs and cattle should cease. And Dr. Sharfstein said farmers should no longer be able to use antibiotics in animals without the supervision of a veterinarian.

In July, Congressional hearings were held to discuss a measure proposed by Representative Louise M. Slaughter, Democrat of New York and chairwoman of the Rules Committee. It would ban seven classes of antibiotics important to human health from being used in animals, and would restrict other antibiotics to therapeutic and some preventive uses.

These drugs are penicillins, tetracyclines, macrolides, lincosamides, streptogramins, aminoglycosides, and sulfonamides, along with any other drug used to treat bacterial illness in people.

The legislation is supported by the Union of Concerned Scientists, Pew Environment Group, and the American Medical Association, among other groups, but opposed by farm organizations like the National Pork Producers Council. The farm lobby’s opposition makes its passage unlikely, but advocates are hoping to include the measure in the legislation to revamp the health care system.

Of course, we know how famously well legislation to revamp the health care system is faring. It’s been watered down many times by interest groups – primarily the insurance and drug companies – who have much to lose if the status quo is upended.

The use of antibiotics for “purposes other than for the advancement of animal or human health should not be considered judicious use,” Dr. Sharfstein said in his written testimony. “Eliminating these uses will not compromise the safety of food.”

Much of Dr. Sharfstein’s testimony summarized information that has been widely accepted for years by medical groups.

Robert Martin, a senior officer at the Pew Environment Group, which has paid for an advertising campaign to support the measure, said the prospects for the measure’s passage were improving.