With vast and profitable markets up for grabs, drug companies are aggressively reaching beyond doctors and taking their marketing messages directly to consumers.
Some of their promotional strategies have become hard to miss. Nightly news broadcasts -- a beloved habit for aging Americans -- are brought to you by the makers of prescription medications for high cholesterol, arthritis, Alzheimer's disease and erectile dysfunction; an Internet search for a specific symptom, or a visit to any popular health site, will bring up sponsored links and blinking ads for at least one prescription medication used to treat that symptom; fans of NASCAR see Viagra advertised every time No. 6 Mark Martin's car rounds the track. And women paging through a magazine for tips on reducing clutter can scarcely avoid the faces and personal stories of actresses who are managing their depression, osteoporosis or hot flashes with a brand-name pill.
In 1997, the FDA loosened regulations governing the advertisement of prescription medications directly to consumers. The change set off explosive growth in marketing aimed at a general audience long on interest and -- compared with physicians -- short on professional skepticism. Today, drug makers spend roughly $5 billion a year to run advertising campaigns that use many of the same appeals that marketers use to sell breakfast cereal and toothpaste.
A study published in the Annals of Family Medicine's January-February issue analyzed the messages of 38 advertisements then running during prime-time TV and found that 95% used emotional appeals to sell the medication, often framing prescription-drug use as a means to regain lost control over some aspect of life. None mentioned lifestyle change as an alternative to product use, although roughly 1 in 5 advertisements suggested it might be a useful complement to the drug. One in 4 described the causes of the disease the advertised drug treats, who is at risk for it or how frequently the condition occurs in the population. The study's authors, led by UCLA researcher Dominick L. Frosh, suggested that without such information, consumers would have little reason to see prescription medication as a solution that involves risks as well as possible benefits.
In all, 58% portrayed the advertised drug as a medical breakthrough -- a pharmaceutical twist on Madison Avenue's "new and improved" message.
"It is time to ban direct-to-consumer advertising of prescription drugs," wrote Dr. Kurt Stange, editor of the Annals, in an accompanying editorial. The advertisements consumers see "distort the relationship between patients and clinicians. [They] manipulate a patient's agenda and steal precious time away from an evidence-based primary care clinician agenda that is attempting to promote healthy behavior, screen for early-stage treatable disease and address mental health."
Even after 23 major pharmaceutical companies agreed to a new slate of voluntary guidelines limiting their advertising, Stange wasn't buying it. Self-monitoring, he wrote, "is not working . . . and cannot realistically be expected to work."
PhRMA, the drug manufacturers' industry group, says direct-to-consumer advertising empowers patients to take an active role in their healthcare and spurs them to discuss symptoms, diseases and treatment options with their doctors that might otherwise go unraised. The industry group frequently cites a 2002 survey of consumers that found that 43% were spurred by a prescription-drug ad to look for more information about the drug or their health.
Although direct-to-consumer advertising has spurred the most political and professional debate, it is only the most visible means of prescription-drug marketing aimed at the consumer. To build markets and encourage consumer loyalty to their products, drug makers have invested heavily in a tactic known to public relations professionals as "third-party marketing." Through voices, groups and activities that seem independent of them -- but frequently are not -- drug companies have found another way to get their messages to consumers.
According to an article published in the British Medical Journal in 2003, the top five public relations firms specializing in healthcare earned $300 million in 2002. These firms "are expert at 'third-party technique' -- helping the drug industry separate the message from what could be seen as a self-interested messenger," wrote authors Bob Burton and Andy Rowell.