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The bizarre Americanness of prescription drug commercials

Before you’d heard of Ozempic, constant TV ads made sure you knew the Ozempic song.

An Opened Prescription Medicine Bottle Among Many Other Sealed Bottles on Yellow Background High Angle View.
You probably know the names of tons of medicines you’ll never need.
Getty Images/MirageC
Emily Stewart covered business and economics for Vox and wrote the newsletter The Big Squeeze, examining the ways ordinary people are being squeezed under capitalism. Before joining Vox, she worked for TheStreet.

Long before I knew what Ozempic did — or had read the deluge of stories about the drug’s off-label weight loss promise — I knew the Ozempic song. Set to the tune of the ’70s Pilot hit “Magic,” the song from the ad has permanently imprinted the name of the medication in my brain. That’s the point — it’s probably one of the reasons Ozempic, which was originally developed and is still sold nominally as a diabetes drug, has taken center stage in the current cultural debate over weight-loss medications rather than Wegovy, which is the same drug, made by the same company, but approved for weight loss.

If you are not from the United States (or New Zealand, the only other country that allows drugmakers to market their prescription products directly to consumers), the volume of drug ads on television in America can feel jarring. When Oprah Winfrey’s bombshell interview with Prince Harry and Meghan Markle aired in March 2021, the British tuned in, and many were gobsmacked at the number of drug commercials they saw. “American medical adverts are some real dystopian shit how you gonna tell me I might die,” one person tweeted. “American healthcare truly is a business,” remarked another.

Most consumers in the United States know the names of a litany of pharmaceuticals they’ll never come into contact with or need, thanks to the commercials that fill our airwaves day in and day out. Drugmakers spend some $6 billion on direct-to-consumer advertising each year. The hope, on the part of pharmaceutical companies, is first that people will learn the names of those drugs, and then get more or less a vague idea of what they do or at least what body part or condition they’re associated with. The ultimate goal is for some of those people to decide to go to the doctor and ask about them.

“The real benefits of these drug advertisements is getting people to talk about the drugs,” said Adrienne Faerber, an independent researcher and expert in drug market advertising and regulation. “In this process, nobody is learning anything about these drugs and how they work on the body and whether they’re effective and whether they’re of good value for the money.”

Prescription drug commercials weren’t always so prolific in the US. The first such ad ran in 1983 and promptly was taken down. Then in 1997, the Food and Drug Administration, which regulates such ads, relaxed its guidelines around broadcast advertising, opening the floodgates. Now these types of commercials are a fixture on American TV, and calls to curtail them or even require them to say how much the drugs they’re selling cost have gone nowhere. Companies have free speech rights, including to try to sell you prescription medications as you try to catch the local news.

“We are somewhat uniquely positioned in the world because of the First Amendment and how courts have interpreted the First Amendment to protect commercial speech,” said Patricia Zettler, a law professor at the Ohio State University Moritz College of Law. “Good, bad, or indifferent, I don’t think they’re going away anytime soon.”

In other words, the cat’s out of the bag, the horse has left the barn, and direct-to-consumer pharmaceutical ads are not going anywhere. So what does that look like?

“Prescription drug ads unquestionably increase demand for prescription drugs, and the question is is that mostly a good thing or a bad thing? I don’t know that we know the answer to that question,” said Julie Donohue, professor and chair in the Department of Health Policy and Management at the University of Pittsburgh’s School of Public Health. Some advertisements could inform patients about underdiagnosed and untreated conditions as well as treatments for those conditions and their effectiveness. “That’s good,” she said, “but there could be a class of medications advertised where there could be cheaper alternatives, or lifestyle changes could be beneficial.”

These ads don’t seriously get into risk-benefit assessments to determine whether the potential benefits of a drug outweigh its possible risks, and all drugs have risks. One paper found that of the top-advertised drugs from 2015 to 2021, fewer than one-third had high therapeutic value, meaning they provided at least a moderate improvement in clinical outcomes compared with existing treatments.

George Porter, a professor at the University of California San Diego, recently came across an ad for Vuity, a prescription eye drop that’s supposed to help with blurry vision, and reached out to his ophthalmologist to ask what he thought of it. “I didn’t get a response back from my doctor, I just got a message from CVS that my prescription was ready,” he said. Initially, Porter thought his insurance would cover part of the drops, but it didn’t, so he ponied up $79 for a 19-day supply. He tried them for three days in a row, and as far as he could tell, they did nothing for him. “I should have just invested, like, $150 in a pair of really, really good reading glasses,” he said. AbbVie, the maker of Vuity, said its policy is not to comment on individual patient cases and noted that in trials, some Vuity patients saw an improvement as soon as day one, but for others it took up to 30 days.

If someone goes to their doctor because they saw a drug on TV and they’re wondering whether it might be right for them, it shifts the burden to the doctor on what to do — a doctor who’s also being marketed to in myriad ways by the pharmaceutical industry. (The budget for marketing to doctors is actually much larger than it is for consumers, a separate and more invisible issue we won’t get into here.) A patient can’t self-prescribe a drug; they have to get a physician to do it. “They’re really the ones to help patients navigate which medicines to take,” said Meredith Rosenthal, a health economist at Harvard. “If the advertised medicine isn’t the thing that the doctor typically prescribes, they’re not going to get that, but it will increase the chances of being treated with some kind of medicine.”

“To me, the big policy question is can we make sure prescribers … are armed against just [deferring to] the patient saying, ‘I’ve seen this new diet drug, diabetes drug, on the internet, can I have it?’” Rosenthal said. “You want doctors to be thoughtful about that.”

Porter has known his ophthalmologist for quite some time, but he was a little surprised he just sent over the prescription. “I was actually expecting to ask some questions about effectiveness and safety, and they just sort of pushed the prescription without saying anything about it,” he said.

A pharmacist in Washington with 30 years of experience, whom Vox granted anonymity in order to speak freely on the matter, says she often has patients come up to the counter to inquire about different drugs they see in ads and online. Lately, she’s had patients come in asking about weight loss medications and HIV treatments. “You want patients to advocate for themselves, but they’re being fed stuff like kids are being fed sugary cereal ads,” she said. She worries providers feel pressure to give patients the drugs they ask for because they’re nervous otherwise they’ll get bad reviews online. “It puts doctors in a position of thinking, ‘Well, it’s not really going to hurt them, I don’t really want them to have it, but they’re going to fill out some survey saying I wasn’t listening to their needs and I’m a horrible provider,’” she said.

Twenty-five years of these ads on television has led us to absorb a lot of ideas about the “medicalization of certain conditions,” such as erectile dysfunction, a popular subject of drug commercials, Rosenthal said. “That has to have an effect on the way we perceive health and medicine as being a product, a solution to health problems that are often more complicated and more situated in a social context,” she said.

It’s not just ads for specific drugs that manufacturers spend money on — they run disease awareness campaigns as well, as a more roundabout way to get people into the doctor’s office. “There’s a campaign that says, are your eyes dry? Maybe you have dry-eye disease, here’s a quiz you can take to see if you have it or not, take this information to your doctor,” said Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute.

Pharmaceuticals and health care in the US are primarily a business, one where corporations trying to maximize profits constantly loom. Companies don’t spend billions to run drugs ads on TV because they’re worried the public is uninformed about treatments for depression or STIs; it’s because they think doing so will be lucrative.

Most experts I spoke to for this said one conundrum here is that there isn’t a ton of good, extensive research about the exact impact of direct-to-consumer prescription drug advertising. In 2016, a report from the Federal Trade Commission found that prescription drug ads caused an uptick in online searches for the drug in question and others like it. A 2021 review of studies acknowledged that the impact of direct-to-consumer advertising in pharmaceuticals was poorly understood; however, the researchers determined that such advertisements prompt patient requests for new drugs and that studies suggest many doctors comply with those requests. Some research shows it could lead to inappropriate prescribing. One of the best studies on the effects of pharmaceutical ads was done in the early 2000s, looking at patient requests for antidepressants. It found that a “thoughtful” direct-to-consumer campaign could encourage patients to seek effective care but could also promote prescribing antidepressants for patients with pretty minor symptoms.

Faerber said that, at this point, the spending is to a certain extent about keeping up with other pharmaceutical companies in the advertising space. “It’s not helping anybody to make better decisions on what medicines they should take, what medicines are appropriate for them, etc., and in the grand scheme of things, there’s also all these really brilliant marketing communicators out there that are spending a lot of their time and energy in almost an arms race of advertising expenditures,” she said.

It’s an arms race that could ultimately contribute to the ever-increasing costs of prescription medications in the US, which lawmakers and regulators have struggled to get under control. The Inflation Reduction Act, in 2022, makes some headway by allowing Medicare to negotiate some prescription drugs prices, but it’s not a panacea. America still far and away outpaces other countries on prescription medication spending.

Some experts worry direct-to-consumer advertising makes the situation worse by increasing demand for newer, higher-cost drugs — even when there are lower-cost alternatives — across the country. In 2018, one study found that direct-to-consumer drug advertising doesn’t provide accurate and balanced information to patients and “is most certainly leading to increased costs for the systems and for patients.” Direct-to-consumer ads may not be the main driver of America’s prescription drug affordability crisis — that has more to do with the fact that we let pharmaceutical manufacturers charge whatever price the market will bear — but they’re not helping, either.

“There are real concerns about the sort of efficiency loss associated with prescription drug ads, that it’s going to drive drug spending in a way that is harmful to consumers and ultimately harmful to taxpayers,” Donohue said. “The cost of prescription drugs and unregulated drug prices are a driving concern behind prescription drug advertisements.”

If you believe the argument there’s value in educating people about different new drugs and certain conditions, that’s fine, but at the very least, it’s worth questioning whether we want drug companies doing it. “Someone else should be doing it, not the companies with a vested interest,” Woloshin said.

He and fellow researcher Lisa Schwartz also pushed for years for drug fact boxes that look like nutritional labels on packaging, which they think would help patients be more informed about what they’re thinking of taking. In a country where direct-to-consumer drug ads aren’t going away — and they really, really are not, thanks to the First Amendment and protected commercial speech — maybe this could at least be a step in the right direction. “The question is, how can we make them better?” Woloshin said. “And this is one way to do it.”

We live in a world that’s constantly trying to sucker us and trick us, where we’re always surrounded by scams big and small. It can feel impossible to navigate. Every two weeks, join Emily Stewart to look at all the little ways our economic systems control and manipulate the average person. Welcome to The Big Squeeze.

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