In 2006, pharmaceutical giant Pfizer launched a $258 million advertising campaign for Lipitor, a high cholesterol treatment. One ad showed Dr. Robert Jarvik M.D. expertly rowing across a lake. Yet unbeknownst to most viewers, Pfizer used a body double to stand in for the doctor. The advertising campaign, while lucrative, was widely criticized for misleading the consumers about both Dr. Jarvik’s involvement with Lipitor’s development and his rowing abilities. Pfizer eventually canceled the ad campaign in 2008 and apologized for misleading the public.
This Lipitor incident is an example of direct-to-consumer advertising (DTCA) of prescription medication, which is prohibited in nearly every country. Only two nations—New Zealand and the United States—permit DTCA of prescription drugs. DTCA is dangerous for patients and expensive for consumers, and demonstrates how pharmaceutical companies have a greater allegiance to their bottom line than to the common good. It is therefore crucial that the erosion of DTCA regulations be stopped, despite the judicial system often siding with pharmaceutical companies by ruling that DTCA falls under the category of free speech.
DTCA has directly contributed to the rise of medicalization and the labelling of non-medical conditions as medical conditions, which is harmful for consumers. Through medicalization, pharmaceutical companies routinely market conditions that are clinically undefined—and sometimes nonexistent—in order to generate demand for their products. In 2004, pharmaceutical giant Proctor & Gamble invested $100 million into research and development (R&D) for Intrinsa, a drug intended to treat female sexual dysfunction. In addition to the R&D expenses, Proctor & Gamble invested another $100 million into marketing efforts to convince females that they suffered from sexual dysfunction and low sexual desire, thus medicalizing the condition. Intrinsa was ultimately rejected by the FDA because of a lack of clinical consensus as to what female sexual dysfunction is, resulting in losses for Proctor & Gamble that ultimately led to price hikes of other products in their portfolio. Intrinsa’s flop was not an anomaly; pharmaceutical companies regularly expend millions of dollars on DTCA campaigns for drugs that are later recalled.
In addition to bringing innovation-killing, costly medicalization, DTCA of prescription drugs can be harmful to consumers’ health. In 1999, Merck spent $160 million on DTCA for Vioxx, a supposedly safe, non-steroidal anti-inflammatory drug. Vioxx went on to cause 140,000 heart attacks and strokes and approximately 45,000 deaths. Vioxx was eventually recalled when a number of adverse effects like these came to light. Yet far before its recall, Merck was aware of the fatal side-effects associated with Vioxx, choosing to sit on the information to protect its costly investment rather than its consumers. This example highlights that DTCA costs cause companies to avoid reporting adverse outcomes caused by their products, risking the health of real people in the process.
Furthermore, DTCA is unnecessarily costly to consumers, as the expenses of DTCA for prescription medicines lead to increases in drug prices. In a study on Clopidogrel, an antiplatelet medication, the cost of the drug rose after a DTCA campaign. Clopidogrel’s DTCA began in 2001, and from 2001 to 2005 the DTCA campaign cost Bristol-Myers Squibb and Sanofi $350 million. During that same time period, there was an increase of $207 million in Clopidogrel pharmacy expenditures for 27 state Medicaid programs with no increase in the units of Clopidogrel sold. These data reveal how increases in marketing and advertising expenses resulted in increases in the price per unit of Clopidogrel, thus making it more expensive and less accessible. Still, Clopidogrel is just one look into an incredibly dangerous pattern. If DTCA is to continue unrestrained, consumers’ access to medicine will only decrease further.
For all of its harmful effects on consumers, DTCA still circulates for one key reason: Simply put, it is in the financial interests of pharmaceutical companies to heavily invest in DTCA. By some estimates, a 10% increase in a pharmaceutical company’s DTCA expenses is associated with a near 1% increase in that company’s annual revenues. In recent years, pharmaceutical companies have successfully lobbied for DTCA protections, resulting in a 20% tax deduction on DTCA expenses for pharmaceutical companies. Clearly, DTCA is in the financial interests of producers far more than the medical interests of consumers.
Unsurprisingly though, DTCA of prescription medication has been contested in U.S. courts for decades, particularly because of questions regarding DTCA’s connection to the First Amendment’s Free Speech clause. In 1976, for example, a 7-1 ruling by the Supreme Court in Virginia State Pharmacy Board v. Virginia Citizens Consumer Council determined that having an economic interest does not disqualify a corporation from First Amendment protection. Therefore, the courts ruled, pharmaceutical companies are allowed to advertise drugs and drug prices to audiences of their choosing.
Countless other Supreme Court rulings have rolled back the advertising restrictions on pharmaceutical companies too, including Washington Legal Foundation v. Henney (2000), Sorrell v. IMS Health (2011), and Amarin v. FDA (2015). These rulings have collectively eroded FDA authority over the practice of DTCA for prescription medicines, and they have also consistently favored the financial interests of large pharmaceutical companies over the public interest. Although pharmaceutical giants claim otherwise, touting DTCA as a way to serve the public interest by increasing the uptake of drugs in communities previously unaware of certain drugs’ existence, DTCA’s supposed benefits are simply false.
Overall, it is preposterous that pharmaceutical companies devote an equal amount of financial resources to research and develop a drug as they do to market the drug. Pharmaceutical companies should prioritize innovation for the wellbeing of the consumer over marketing for the wellbeing of the business. These companies have made it clear time and time again that their fiduciary duty to their investors trumps their moral obligation to the public. Thus, it is imperative that any guardrails keeping DTCA in check remain in place; consumer’s lives, and wallets, depend on it.