Drug Ads, Pro & Con
From USA Today June 12, 2005

Restricting drug ads not a good prescription
"Ask your doctor if (insert name of latest wonder drug) is right for you."

Some version of that TV commercial seems to replay in an endless loop, along with the accompanying litany of unpleasant side effects.

Direct-to-consumer drug ads are banned in most of the world, and some physician and consumer groups want them stopped or severely limited in the USA also. Such ads, they argue, encourage overprescribing, drive up health care costs and interfere with the doctor-patient relationship.

There's no doubt some truth to that. But the proposed bans miss the mark and are of dubious constitutionality. American courts have consistently upheld legitimate commercial speech, noting that the public's right to be informed about products and services can be as important as political speech. As offensive as some ads are, pharmaceutical firms have a right under the First Amendment to engage in honest promotion.

The key word is honest.

Touting one's product as the greatest thing since sliced bread is fine for, well, bread. But potent medicines are different. False statements and unrealistic promises invite injuries and even death.

That's why the Food and Drug Administration (FDA) reviews more than 30,000 pieces of promotional material a year and has the power to demand that drugmakers pull misleading ads. The problem, as USA TODAY's Julie Schmit reported recently, is that the agency has only 40 overwhelmed people to make sure the avalanche of ads — $4.1 billion last year alone — is accurate and balanced.

Stricter and more timely FDA scrutiny is needed, along with more cooperation from the pharmaceutical industry. The industry promises a voluntary code of conduct later this summer. The code would state that the drug ads should be educational, directed only to patients likely to benefit, and honestly spell out the risks, says W.J. "Billy" Tauzin, president of the Pharmaceutical Research and Manufacturers of America.

Some members of Congress don't want to wait:

•A bill by Rep. James Moran, D-Va., would ban erectile-dysfunction TV ads from 6 a.m. to 10 p.m., sparing parents from having to explain four-hour you know whats.

•Sens. Chuck Grassley, R-Iowa, and Christopher Dodd, D-Conn., have introduced legislation that would require drugmakers to submit all ads for new drugs to the FDA up to two years before they can be aired.

That isn't realistic or fair. Many drugmakers already submit ads in advance, but the overburdened FDA staff can't review them in a timely way. Why should patients be denied knowledge about drugs the FDA has already approved?

However annoying, the ads have benefits. They urge people to discuss health issues with their doctors, and some patients with a stigmatized condition, such as depression or impotence, open up and get needed care.

Patients may irritate doctors by demanding the latest drug touted on TV, but it's up to physicians to decide whether prescribing it is wise. If it's not, saying "no" is simply practicing good medicine, even if it takes more time.

Restricting truthful promotion would deprive patients of information they're entitled to. Tough, timely enforcement against misleading ads, along with more candor from the pharmaceutical industry about drugs' risks and limitations, are better remedies.
 
 

 

 Take drug ads off the air
By Robert M. Centor
Direct-to-consumer drug advertising works very well — for pharmaceutical company profits, but not for the public health.

Repeated television commercials make drug-trade names familiar to the public. Take this test. Do you recognize these names: Procrit, Detrol, Nexium, Levitra, Vioxx, Enbrel? Do you know what problems these drugs treat? You probably know all the names but likely know only half the medical conditions for which they're prescribed.

Television advertising caused the market for Vioxx to expand greatly beyond the patients for whom it was intended. Physicians should have prescribed Vioxx only when a patient had gastric side effects from older, less expensive arthritis drugs. But ads convinced patients (and too many physicians) of this medicine's superiority and safety. Unfortunately, neither belief was true.

Several articles in leading medical journals have documented that drug advertising influences patients' requests, and that busy physicians often fill those requests even when they believe a patient might do just as well with another medication.

Some argue that the First Amendment protects direct-to-consumer drug advertising. However, restrictions on commercial speech exist when the outcome of the speech can be harmful to the public. The Federal Communications Commission no longer allows tobacco ads to appear on TV. Following the same logic, prescription-drug ads should be taken off the air.

Drug advertising results in more costly prescriptions. Few inexpensive drugs are advertised on TV. The commercials don't educate patients. Rather, they create a demand for a product based on an effective commercial rather than the patient's medical need.

In an ideal world, the physician could take all the time necessary to explain why the drug isn't right for that particular patient. But physicians have limited time. Discussing these requests causes two problems: Other important issues are set aside, and physicians must decide whether to have a lengthy discussion or take the course of least resistance, acceding to the insistent requests.

Direct-to-consumer ads should be banned. Doctors and patients have much to gain. Only the pharmaceutical industry has anything to lose.

Robert M. Centor, a professor of internal medicine at the University of Alabama School of Medicine, writes frequently on medical issues on his blog, www.medrants.com