Selling Prescription Drugs via Direct-to-Consumer Advertising

“Next year, how about fewer ads that fuel opioid addiction and more on access to treatment,” White House Chief of Staff Denis McDonough complained on Twitter.

“Was that really an ad for junkies who can’t [poop]? America, I luv ya but I just can’t keep up,” TV host Bill Maher tweeted.

These are only two insensitive comments that were made by high-profile individuals in response to AstraZenca’s 2016 Super Bowl ad, “Envy.”

The ad was part of a campaign to increase awareness of opioid-induced constipation (OIC) and to sell Movantik, a medication to treat it. OIC is a serious problem for some pain patients who use opioids. Critics of “Envy” complained that the Super Bowl ad supported opioids and, by extension, promoted addiction.

The negative response that “Envy” elicited is an exception to the apathy that seems to greet the vast number of drug ads on television these days. Most people don’t seem to have a problem, conceptually, with marketing drugs to consumers. Their problem seems to be limited to marketing opioids and anything related to them.

Prescription drug ads are ubiquitous. Some people claim the high price of those commercials has contributed to the cost of healthcare in the United States.

Advertising seems to have become accepted as a major part of marketing most drugs. However, opioids are one of the few drugs that are not marketed to consumers.

The FDA  Provides Guidelines for Prescription Drug Advertising 

Ads for the 2017 Super Bowl cost $5 million for a 30-second spot. According to ProCon.org, “The $395 billion US pharmaceutical industry spent $5.2 billion on advertising prescription drugs directly to consumers in 2015.” Some drugs are primarily marketed through direct to the consumer (DTC) ads. This reality is limited to the United States and New Zealand which currently are the only two countries that permit DTC ads.

According to the U.S. Food and Drug Administration (FDA), “Prescription drug advertisements can provide useful information for consumers to work with their health care providers to make wise decisions about treatment.” Their web site even provides a series of ads that serve as examples of best, and worst, practices in directly marketing prescriptions to patients.

The FDA’s viewpoint is controversial. In fact, some insurers and policymakers believe that government should formulate regulations for prescribing medications, and that their guidelines should outweigh the opinions of patients and their doctors.

When television advertising for prescription drugs began, in the 1980s, the FDA prohibited drug companies from explaining the purpose of the drug. That led to the broadcasting of such questionable advice as “ask your doctor if the purple pill is right for you.” The ad that used the tagline was aimed at all television viewers and undoubtedly led to a great deal of wasted time as doctors fielded unnecessary questions from their patients about a purple pill they knew nothing about.

While the FDA still oversees DTC advertising for prescription medication, its rules have changed. “Product claim advertisements” currently are allowed to describe a drug’s benefits and risks. The manufacturers’ claims must not be misleading, and the advertisement must use language that consumers can understand. Those safeguards were implemented to protect consumers, but they may be insufficient.

Images of radiant grandparents who are able to chase their smiling grandchildren and puppies around the park because they took the right medication for various ailments can be powerfully persuasive. Who doesn’t want to be happier, more energetic, more agile, and more fully able to participate in all of life’s adventures?

It is true that DTC ads are obligated to delineate a drug’s risks as well as its benefits. But, by the end of the advertisement, consumers might be so smitten by the images they’ve absorbed that their hopes overrule their common sense and override their sense of caution.

Advertisements are able to persuade viewers to consume junk food. In much the same way, DTC ads can convince some patients to lobby their doctors to prescribe drugs they don’t need. That might be dangerous.

So the FDA pays a lot of attention to DTC advertising of other prescription drugs even as it allows manufacturers to spend millions of dollars on those commercials. The fact that opioids belong to a class of drugs that are not marketed directly to consumers doesn’t keep journalists and others from asserting that excessive marketing by Pharma is the major reason for today’s opioid crisis. The national narrative is that opioids have been over promoted. That may be true, but it isn’t because of advertising to consumers.

It is true that Pharma markets all drugs heavily to physicians. Opioid marketing is no exception. But, whereas DTC ads target consumers, opioid marketing does not.

The Attack on the OIC Drug During the 2016 Super Bowl 

This is why the attack on the OIC drug during the Super Bowl seemed misplaced. It reflected a cultural attitude towards people who use opioids for pain and the doctors who treat them. In fact, the negative reaction to the Super Bowl ad was a denigration of a large swath of society of people in pain.

DTC prescription drug ads may or may not be appropriate for society. Opinions vary.

However, educating the public about OIC and how it can be treated is not the same as promoting opioids. The “Envy” ad disseminated the type of information the FDA believes is useful to potential consumers. Marketing opioids to prescribers is an entirely different issue, and it may or may not be appropriate. That deserves its own debate.