There are only two countries in the world where drug manufacturers are allowed to advertise their products directly to consumers: the United States and New Zealand.
Drug companies in the United States spend $4 billion a year on TV ads alone. The typical TV drug ad these days usually touts the benefits of a drug—maybe with a lot of singing and dancing—and closes with a brief, rapid-fire list of possible side effects, as parodied on Saturday Night Live.
That’s about to change. After 15 years of studying the matter, the U.S. Food and Drug Administration (FDA) is going to require that the ads show less about the benefits and more about the side effects and risks. A new bill in Congress would impose similar restrictions on social media platforms.
Ad Value
Under President Donald Trump, the regulations could become even harsher. Robert F. Kennedy Jr., Trump’s pick to head the Department of Health and Human Services, has said he wants to ban drug ads. Kennedy claims drug ads are such an important source of revenue for the networks that they influence what is allowed on the regular programming (e.g., avoiding criticism of pharma).
Here is what the regulators and would-be regulators are missing. Our most important health care problem is not that people are taking too many prescription drugs. They are taking too few.
The social value of drug advertising is that it alerts patients to the fact that there is a possible remedy for a chronic illness. The payoff is that the viewer might seek medical advice from a doctor and get a prescription, where appropriate.
There is no social value in ads that list risks and negative side effects. The information will always be too clipped to be understandable; it won’t be remembered anyway, and it is useless unless a doctor finds the patient is a candidate for the drug.
The time to discuss side effects is when patients are under a doctor’s care.
Drugs Provide Best Return
Studies show that we get our best return in medicine from drugs. Per dollar spent, the return on investing in drug therapy is much higher than what we are getting from investing in doctor care or hospital therapies.
For example, Columbia University’s Frank Lichtenberg has estimated that three quarters of the increase in life expectancy that we’ve enjoyed in recent decades resulted from our adoption of modern drugs.
We are underinvesting in drugs, as reflected in undertreatment rates for chronic illnesses in this country.
Take diabetes, for example. Studies show that only 2.4 percent of people with prediabetes receive a prescription for metformin (the preferred treatment) within a year of their diagnosis. Even among obese patients, the figure is only 10.4 percent. Three years after an initial diagnosis, when the patient is even more susceptible to the disease, the treatment rate is still surprisingly low: 3.9 percent overall and only 14 percent for obese patients.
Or consider hypertension. One out of every four patients with the problem is not being treated at all. Only half of adults with hypertension have their blood pressure under control.
Noncompliance Problem
Almost as bad as not getting the prescription people need is not taking the drug once it is in hand. Both problems arise for similar reasons.
Nearly half of all Americans suffer from at least one ongoing or chronic health condition, and nearly half of these are not adhering to a needed drug regime.
There are an estimated 125,000 deaths per year in the United States due to medication nonadherence. Further, an estimated 33 percent to 69 percent of medication-related hospital admissions result from poor adherence. The total cost estimates for medication nonadherence range from $100 billion to $300 billion every year, when both direct and indirect costs are included.
Nonadherence and failure to get a prescription in the first place occur for a variety of reasons: lack of information, misinformation, and unfounded fear, all of which can be combatted with more, not less, information.
Value of Off-Label Use
Not only are the new rules ill-advised, the ones in force right now are already causing considerable harm. That’s because a drug prescribed by doctors—no matter how useful and widespread the application—cannot be advertised, even to doctors themselves, unless the use has been FDA-approved.
Once a drug has been approved for one use by the FDA, doctors may find it has other uses, even though the effectiveness of these other uses has never been studied through an FDA-approved trial. These are called “off-label” uses. About 10 to 20 percent of all prescriptions are for off-label uses.
It is hard to exaggerate how unreasonable FDA regulations are in this regard. If researchers publish findings on the off-label use of a drug in the New England Journal of Medicine, a drug company is not allowed to share that article with doctors. If they do, the drug company’s decision-makers could wind up in prison!
When it comes to the potential of drugs to treat chronic conditions, more information is better than less. This is especially true in an age when there is so much misinformation on the internet.
We should let people learn about the positive benefits of drugs from TV ads and other venues. That will encourage them to seek a doctor’s counsel. The doctor’s office is the place where risks and side effects should be discussed.
John C. Goodman, Ph.D. ([email protected]) is co-publisher of Health Care News and president and founder of the Goodman Institute for Public Policy Research. A version of this article was published by Forbes. Reprinted with permission.
John C. Goodman is president of the Goodman Institute for Public Policy Research
