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Bruce Horovitz and Julie Appleby, Kaiser Health News
Bruce Horovitz and Julie Appleby, Kaiser Health News
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Laura Ries was moved to action when she saw a TV commercial that portrayed a woman enjoying time with her grandchildren after taking Lyrica, a prescription medication for diabetic nerve pain. Ries’ elderly mother suffered from just that problem.
“The ad showed someone who was enjoying life again,” said Ries, president of a marketing strategy firm in Atlanta, who then researched the drug and spoke with her mother’s doctor. “This … was very relatable to what my mom was experiencing.”
Her reaction was precisely the aim of direct-to-consumer (DTC) advertising: getting patients or their family members to remember a drug’s name and ask by name for a prescription.
Spending on such commercials grew 62 percent since 2012, even as ad spending for most other product types was flat.
“Pharmaceutical advertising has grown more in the past four years than any other leading ad category,” said Jon Swallen, chief research officer at Kantar Media, a consulting firm that tracks multimedia advertising. It exceeded $6 billion last year, with television picking up the lion’s share, according to Kantar data. Shows such as the major network’s evening news programs, the CBS comedy “Mike & Molly” and ABC’s daytime drama “General Hospital” are heavy with drug ads, Kantar data show.
But the proliferation of drug advertisements has generated new controversy, in part because the ads inevitably promote high-priced drugs, some of which doctors say have limited practical utility for the average patient-viewer. The cost of Lyrica, the drug Ries was asked about for her mom, is about $400 for 60 capsules, for example. Critics say the ads encourage patients to ask their doctors for expensive, often marginal — and sometimes inappropriate — drugs that are fueling spiraling health care spending.
The American Medical Association took a hard-line position on these ads in 2015 by calling for a ban, saying “direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”
Such a prohibition is unlikely. Previous efforts to push such an outcome have stalled, generally on free-speech arguments by the powerful drug lobby and assertions that such ads provide valuable information to patients about treatment options.
One thing is certain: DTC advertising is big. And, as nearly everyone who watches TV knows, it’s getting bigger.
Some programs — the nightly news and sitcoms aimed at older Americans — get most of their advertising from drugmakers. A Kantar analysis shows 72 percent of commercial breaks on the “CBS Evening News” have at least one pharmaceutical advertisement. Commonly, the ads target a range of conditions that generally affect this demographic, such as dry eyes, erectile dysfunction, pain and constipation. Sixty-two percent of commercial breaks during “General Hospital” include a drug ad.
“A lot of these ads target the caregivers and the children of older folks,” said consultant Tom Lom, a former managing partner of Saatchi & Saatchi Consumer Healthcare, which has created ads for pharmaceutical giants from Pfizer to Merck.
Drugmakers were on track to spend an estimated $6.4 billion on DTC advertising in the U.S. last year, up 5 percent from 2015, according to Kantar. In 2012, spending for pharmaceutical TV ads was the 12th-largest category. By last year, drug ads were sixth. While substantial, the spending was less than the amount spent by automakers, retail and restaurants. Networks — ABC, CBS, NBC — along with cable channels like CNN — draw a lot of the pharmaceutical advertising. According to Swallen, the effect of the ban on networks would be a daunting, 8 percent loss of total ad revenue, and its impact would be most evident for programming popular with viewers older than 60 — for instance, evening news shows. Similarly, cable networks such as the Hallmark Channel, which draw viewers from this demographic, would feel the pinch because they “have more skin in the game,” he said.
Why Some Drugs Are Advertised
For years, the DTC industry was mostly focused on drugs that relieved chronic, typically non-fatal afflictions like heartburn (Nexium), allergies (Claritin) and high cholesterol (Lipitor).
More recently, Lom said, advertising has focused on cancer and illnesses affecting seniors, such as Alzheimer’s disease. Ads for drugs that target constipation caused by other drugs — opioids — hit the scene last year, reflecting the large numbers of people taking painkillers.
For years, the DTC industry was mostly focused on drugs that relieved non-fatal afflictions like allergies. Advertising has more recently focused on cancer and illnesses affecting seniors. Screenshot by KHN
In 2016, the top three ads based on total spending were Lyrica, with $313 million in spending; rheumatoid arthritis drug Humira at $303 million; and Eliquis, a treatment for a type of heart arrhythmia, at $186 million, according to Kantar.
Reasons why some drugs are advertised more than others vary, with drugmakers evaluating which products are most likely to bring them the most revenue.
Drugmakers don’t care “whether it’s a rare, expensive drug or a popular cheap drug,” said Amanda Starc, associate professor of strategy at Northwestern’s Kellogg School of Management. “They’re looking at the marginal return on advertising. A small number of customers spending a lot or a big number spending a little.”
How Advertising Plays To Consumers
The United States is one of two countries — the other is New Zealand — that allows DTC advertising, a long-standing practice that became more common in the mid-1980s after the FDA issued new rules. Most advertising was in print. But more television advertising began appearing when some of the rules were relaxed a decade later.
Lom said the ads give consumers a “head start” on knowing about drugs that might be available for their ailments, speeding up the consumer education process.
But, surprisingly, 62 percent of physicians, for instance, said they would or might prescribe an innocuous, even placebo treatment to a patient who didn’t need it but demanded it, according to a 2016 poll conducted by Medscape, an online physician education website.
Current rules require that if a drug is named in an ad, information must be included about side effects and adverse reactions. That makes it even more important that drug advertising be visually captivating — if not surprising, say consultants.
The ad for Spiriva, a drug for people with lung diseases that can make it hard to breathe, shows an elephant sitting on actress Jeanette O’Connor’s chest. During the 2016 Super Bowl, viewers saw a man emerging from a restroom with a pleased look on his face in an advertisement about opioid-induced constipation. Cialis, which treats erectile dysfunction, uses images of couples in side-by-side bathtubs, which sticks in consumers’ minds.
Meanwhile, the side effects are glossed over. “They describe the risks at the same time they play pleasant music — or show pleasant pictures — which helps to distract people from getting the message,” says Dr. Aaron Kesselheim, associate professor of medicine at Harvard Medical School.
And while President Donald Trump said he wants to reduce the high costs of prescription medicines, he is also likely to encourage fewer government restrictions on the development and marketing of drugs.
But whether the advertising empowers patients or leaves them vulnerable is debatable.
Those that do advertise, however, appear to have a leg up. Ries, the brand consultant, says it wasn’t just the ad that helped her to remember Lyrica, but the name, too, which was easy to spell and pronounce.
Reis said her mother did take the Lyrica “and it’s helped.” That’s a good thing, says the brand guru who takes pride in looking out for her mom. “The ad spurred the conversation.”
This report is a cross-post from the Kaiser Health News website. KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.
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