Big Pharma and Consumer Confusion: Are we overmedicated?
April 28th, 2011 § Leave a Comment
by Madelyn Smith
May 2, 2011
Exploring the ins and outs of the complicated world of pharmaceutical advertising and prescription drugs in America
www.care2.com
These advertisements range from the informative to the vague, often giving consumers misconstrued ideas about symptoms and the effectiveness of certain drugs. Even before walking into their doctor’s office, patients are exposed to thousands of these advertisements.
Graphic by Madelyn Smith.
Medical Moneymakers
Big pharma is the name given to the largest pharmaceutical companies in the world, which include such big names as Johnson & Johnson, Merck, GlaxoSmithKline, Pfizer, Eli Lilly and Novartis.
“When you compare profits in this country, the number one industry is going to be the pharmaceutical industry and big pharma,” said Dr. Larry Garber, associate professor of Marketing at Elon University and former marketing analyst at Glaxo Pharmaceuticals, now GlaxoSmithKline.
In the documentary “Big Bucks, Big Pharma,” experts said the combined global sales of five major pharmaceutical companies in 2004 was $550 billion. In 2010, global sales were estimated at more than $770 billion.
Drug advertising undoubtedly plays a large role in these successful profits, and in 2009, drug makers spent more than $4.3 billion on ads.
While it seems like drug advertisements are never-ending, pharmaceutical companies don’t actually have the freedom to purchase advertisements as often as they want. There are some factors and regulations that go into the marketing process, Garber said.
www.pharma-marketer.com
Garber added that newer drugs are generally the most advertised, but that the Food and Drug Administration (FDA) ultimately has the ability to regulate the frequency of ads.
“There tends to be a pendulum swing in the degree to which ethical drug companies are allowed to advertise through the FDA,” Garber said. “This is contrary to the free market idea, where the government stays out of business affairs.”
Research is another financial giant in the pharmaceutical industry. Without it, new drugs, and subsequently, advertisements for new drugs, wouldn’t be possible.
And by the time the influx of new drug ads comes along each year, companies have invested hundreds of millions of dollars into intensive research.
“Research is definitely not the most visible part of any drug company,” said Anne Strohmeier, a fourth-year pharmacy intern at Kroger in Louisville, KY and graduate of the College of Pharmacy at the University of South Carolina. “But it’s the most important. Many years of research are invested prior to a drug coming to market, and multiple phases of clinical trials are completed to determine the safety of the drug. It’s a lengthy and expensive process for companies, especially in the U.S.”
Effective advertising
While the sheer number of drug commercials that run on TV may merely be a hum in some people’s ears, the majority of consumers take notice of the ads.
In a May 2010 Consumer Reports survey of 1,150 adults, about one of every five people who take prescription drugs said they suggested a certain drug to their doctor after seeing an advertisement. And of those people, 59 percent said doctors prescribed the drug they requested.
Graphic by Madelyn Smith.
Kitty Parrish, director of health services at Elon University, said the majority of students who come to the Health Center on campus and request specific medications heard about those drugs via TV advertisements.
“Students occasionally request certain drugs,” she said. “And if it is the appropriate drug for the problem, we will prescribe that. But at times, certain drugs are requested, but they are not the drug of choice or may not be effective for that diagnosis.”
“Every day I get patients coming in the office asking for brand name drugs,” said Dr. Alice Wyatt, a nurse practitioner at Kulbersh Women’s Center in Irmo, S.C. “And most of them heard about the drugs from TV. But no matter how effective they think the drug might be, it comes down to patient feedback. They can say, ‘that’s what I should have’ – but is that what they really need? If previous patients with similar conditions had no negative reactions to the drug, I’ll consider prescribing it. Then it comes down to a bit of trial and error. It’s either going to work or it’s not,” she said.
‘Ask your doctor if ____ is right for you’
So advertisements are effective at getting the word out about certain drugs, but are they educating consumers or presenting them with misguided information?
“Advertisements have become not so much about the efficacy of a drug, but about our emotional response to the kinds of social meanings they’ve attached to the product,” said Elizabeth Preston, a Communications professor at Westfield State College, in “Big Bucks, Big Pharma.”
Preston said common traits of drug advertisements are idyllic images of people who have been restored to health after taking the medication. They rarely show the actual medical condition or the symptoms that people supposedly suffer from, she said.
“I think when patients see these images of happy, healthy people in the ads, they can overlook the actual safety of the drug,” said Strohmeier. “People can become confused about the intended use or expected outcomes of a medication.”
Graphic by Madelyn Smith.
Drug advertisements seem to follow similar scripts, ending with a long and often grim list of these “expected outcomes” and possible side-effects – nausea, fainting, headaches, dry mouth, abdominal pain, drowsiness, fever – that the FDA requires.
And the phrase “ask your doctor if [insert prescription drug here] is right for you” is included in most TV advertisements. This statement puts pressure on doctors.
“Telling patients to ask their doctor about a drug allows them to become involved in their health care regimen,” said Strohmeier. “But it also puts doctors in a tough situation – where doctors were once the primary medical expert, many patients now come to doctors with recommendations from TV, the internet, word of mouth – all based on a drug they know very little about.”
Physician and author Marcia Angell, former editor of the New England Journal of Medicine, said in the documentary that consumers should be “smart researchers” and be wary of drug ads they see online or on television.
“It’s absurd to look to a company for impartial education about a drug product,” she said. She added that consumers should not get caught up in the “ceaseless mass marketing” from drug companies and do better research before going to their doctors with requests for certain drugs.
Drugs Sales Reps: The Bridge between Companies and Doctors
Common marketing strategies – TV commercials, magazine ads and internet pop-up ads – are meant to educate consumers and persuade them to buy certain drugs. But the rest of the industry’s promotional efforts come from pharmaceutical sales representatives and are geared toward doctors, pharmacists and healthcare providers.
The FDA aims to give pharmaceutical companies an equal footing in the category of television and print ads, but the face-to-face contact of sales reps can have a larger effect on which drugs doctors choose to give their patients.
“Competition has always been the issue for drug companies,” said Christa Riley, a former representative for Merck, a company known for brands like Singulair and Vytorin, and a current representative for a smaller drug company. “There really is no drug on the market without direct competition. If you’re not competing against another similar drug, you are competing against generic drugs,” she said.
Riley said a typical day as a drug sales representative would include making about 10 calls daily to physicians’ offices, sharing new information about certain drugs and reinforcing the advantages of the drugs. She said also gives doctors several boxes of drug samples to hand out to patients and often arranges informational meetings with doctors’ offices.
Before the FDA’s recent ban on sales representatives’ incentives for doctors, many felt that drug companies and physicians were “too cozy,” said former sales representative Gene Carbona in Big Bucks, Big Pharma. “Pharmaceutical reps had virtually unrestricted budgets for giving doctors incentives to prescribe their drug. It became an issue of education versus mere marketing. There was a thin educational veneer over outrageous promotional spending.”
Such incentives and promotional spending included pens, clipboards, stethoscopes – virtually every major tool physicians used – all labeled with a certain drug’s name.
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Carbona added that it is many industry professionals’ hope that in the future, doctors will rely more on scientific literature than representatives to learn about new drugs.
Another Consumer Reports survey of 49,007 subscribers backed up this claim. It found that most patients were a bit skeptical of doctors who they thought relied too heavily on prescription drugs and their sales representatives, especially those doctors who didn’t look into other options like generic drugs or nondrug treatments.
And while many doctors may come across as unwilling to prescribe a generic drug, this may be due to the amount of samples they receive from drug representatives. These are usually the only samples doctors’ offices have on hand, so doctors are limited to those brand name drug samples instead of generic options.
But it’s important to not view drug representatives as seedy salespeople who persuade and pass out unlimited samples as “bribes.”
“I think it’s ridiculous when people scrutinize the pharmaceutical industry for manipulating doctors by giving them favors,” said Riley. “It can happen in any industry.”
“It’s hard for physicians to keep up, so the industry needs reps,” said Garber. “Good representatives are people who can educate. And advertisements only complement what reps are telling doctors.”
Americans’ Quest for a ‘Quick Fix:’ Are brand name drugs really the best option?
Pierce Jones, a sophomore Biomedical Engineering student at Vanderbilt University, has chosen, if possible, to rarely taken any kind of medication in his lifetime. He would prefer to not experience the undesirable side effects of many drugs.
“I see the necessity in most drugs,” he said. “And I’m not saying that all drugs are bad, just that they should not be the first cure people look at before anything else.”
A term that’s thrown around often in medical talk is “quick fix,” the idea that people want immediate solutions to any and all types of medical problems they experience.
“As a population, we’d rather have a few side effects related to an immediate response than proceed naturally and have to wait longer,” said Jones. “As the most clear example, I feel like too many children are diagnosed with ADHD at too young an age. I’m not discounting ADHD as a disorder, but I am saying that there are probably plenty of children whose rowdiness is mistaken for a chemical deficiency.”
“We can go to doctors to fix things that people wouldn’t have bothered with years ago,” said Garber.
Consumers are sometimes hesitant to accept doctors’ suggestions for generic drugs to fix their medical problems. This may be because the drugs have been around longer and aren’t advertised as heavily as newer drugs, or because consumers doubt the effectiveness of generic drugs.
“What ads won’t tell you is that those newer drugs are often no safer or more effective than older medications that cost a fraction of the price,” wrote Consumer Reports in a March 2011 article and web resource, “Best Buy Drugs.”
Wyatt, who has been in the field of women’s health for more than 20 years, said she has always opted to prescribe generic brands first. If a prescription drug happens to be the clearest, best-fit choice for a patient, she will recommend that instead.
“Unless someone has had a problem with an off-brand, I usually prescribe generics,” she said. “They’re just as good but most importantly for the patient, they’re cheaper.”
The main point many health professionals want to hit home? Don’t fear generic drugs. They may not be advertised as heavily, but they still undergo close scrutiny by the FDA to ensure that their main active ingredients are the same as their matching prescription drugs.
Consumer Reports completed intensive research comparing expensive brand name drugs to their generic counterparts and found that buying generics can save consumers up to 80 percent on monthly drug costs.
And not only should consumers consider generic drugs, they should also question whether their suspected medical problems are really worth medication at all. Research is key, and so is patience.
“People should definitely consider alternatives to medication,” said Jones. “A holistic approach is best to try. Chiropractic has worked for me, as well as massage therapy, vitamins and changes and supplements to my diet.”
With cheaper alternatives like generic drugs and nondrug treatments, consumers may not be as locked into taking prescription drugs as they think. Drug advertisements try to convince people that certain medications are the absolute most reliable drug on the market. But they are obligated to do that – they are, after all, businesses.
And given the emphasis on health in the U.S., it seems almost everyone is taking some kind of pill, even if it means straining their wallets to do so.
But the search for medical solutions – taking generic or prescription drugs, trying nondrug options – stems from Americans’ overall quest for a good well-being and long life expectancy.
“What would we do without the medical industry?” asked Riley. “It’s what keeps people living a peaceful existence.”
The following is a video excerpt from the documentary “Big Bucks, Big Pharma:”
