Selling Snake Oil: Direct-to Consumer Advertising

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Selling Snake Oil Direct-to Consumer Advertising

• James G. Anderson, Ph.D.
• Purdue University

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Ask Your Doctor!One evening on CBS News
Condition Drug
Restless Leg Syndrome Requip
Heartburn (Acid Reflux Disease) Zantac
Allergies Nasonex
Hemorrhoids Preparation H
Pain Advil
Sleeplessness Ambien
Allergies Benadryl
Back Pain Thermacare
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Medicalization

• Defining a problem as a medical illness or a
  disorder requiring medical intervention to treat
  it.

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Expansion of Medical Jurisdiction

• Child birth
• Menopause
• Sexual Dysfunction
• Anxiety
• Childhood Behavior
• Heartburn or Indigestion
• Post Traumatic Stress Disorder
• Obesity
• Hair Loss
• Short Stature

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Engines of Medicalization

• Medical Profession
• Special Interest Groups
• Commercial and Market Interests

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The Pharmaceutical Industry

• Passage of the Food and Drug Modernization Act
  1997 allows for a wider usage and promotion of
  off-label uses of drugs and facilitated
  direct-to-consumer advertising
• Spending on direct-to-consumer advertising
  increased from 1.1 billion in 1997 to 4.5
  billion in 2006.
• The FDA sent only 15 warning letters to drug
  companies regarding ads in 2005 and 22 in 2006.

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Sexual Dysfunction

• In March 1998 the FDA approved Viagra as a
  treatment for erectile dysfunction (ED). Ask
  your doctor if Viagra is right for you.
• Sales were sensational! The first year 3 million
  men were treated with Viagra translating into
  1.5 billion in sales. By 2003, 6 million men
  were taking Viagra and sales rose to 1.7 billion

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Sexual Dysfunction

• With the introduction of Levitra and Cialis the
  drug industry estimates the potential market for
  these drugs to be 30 million men in the U.S.
  alone.
• The drug industry has expanded the notion of ED
  and has begun to encourage the use of these drugs
  as an enhancement to sexual pleasure and
  relationships.

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Anxiety

• Prozac was introduced in 1987 as an
  antidepressant. Paxil was approved by the FDA in
  1996 to treat Social Anxiety Disorder (SAD) and
  Generalized Anxiety Disorder (GAD)
• Marketing diseases and then selling drugs to
  treat them is now common. The tag line is
  Imagine being Allergic to People.
• Paxil is now the prescription drug that is number
  six in sales amounting to 2.1 billion in 2001.

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Childrens Behavior Problems

• Childrens problems constitute a growing market
  for psychotropic drugs.
• Ritalin in particular is being prescribed to
  treat attention deficit hyperactivity disorder
  (ADHD).
• Spending on behavior drugs for children and
  adolescents rose 77 from 2000 to 2003.
• These drugs are now the fastest growing type of
  medication taken by children eclipsing
  aqntibiotics and asthma treatment.

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Short Stature

• Synthetic human growth hormone became available
  in 1985 to treat a rare hormonal disorder.
• Genentech began to market the off-label use of
  their drug, Protropin, for children who were
  short but had no growth hormone deficiency.
• This market has grown since the FDA approved the
  use of Eli Lillys drug, Humatrope, for use with
  short-statured children in the lowest 1.2 of the
  population.

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The Future

• A private market for enhancements for children
  exists.
• Biotechnology companies will work to increase the
  size of this market.
• The promotion and use of biomedical enhancements
  will increase medicalization of human problems.

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The New Drug Epidemic

• 2.1 million teenagers are abusing prescription
  drugs that they obtain from other teens and
  adults (e.g., Adderall, Ritalin, Oxicontin)

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The Human Body

• Cosmetic surgery from tummy tucks to liposuction
  to nose jobs to breast augmentation have become
  big medical business.
• Between 1960 and 1990 there were 2 million women
  who received silicone breast implants. In 2003
  alone, 280,401 breast augmentations were
  performed in the U.S.
• Overall 8.3 million Americans had cosmetic
  medical procedures in 2003, a 20 increase from
  the previous year and a 277 increase since 1997.

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Tummy Tuck
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Price List
Surgery With Airfare Without Airfare
Breast Augmentation 5,000-4,500 4,500-4,000
Breast Reduction 4,750 4,250
Liposuction (3 area) 4,500 4,000
Tummy Tuck 5,500 5,000
Blepharoplasty 3,800 3,300
Nose Surgery 4,500 4,000
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Obesity

• The number of gastric bypass surgeries in the
  U.S. has risen from 20,000 in 1965 to a projected
  144,000 in 2004.
• Bypass operations are becoming an increasingly
  common way to treat problems of overweight. The
  recent Medicare policy shift declaring obesity as
  a disease will further expand the number of
  procedures performed.

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Lapband
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Hawking other Health Productscaveat emptor!

• Diet products
• Herbal products
• Hearing Aids
• Wheel chairs

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Power Chair Jazzy 1170
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Arguments for DTC Advertising

• DTCA serves an important physician and patient
  education function that raises their awareness of
  new conditions leading to greater detection,
  diagnosis, and treatment
• Patients are empowered to seek the best available
  treatment for their conditions
• In some instances, the patient may be better
  informed than their physician
• DTCA stimulates the patient to discuss their
  condition and treatment with their physician
• DTCA is free speech and is protected by the U.S.
  Constitution

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Arguments for DTC Advertising

• DTCA stimulates the patient to discuss their
  condition and treatment with their physician
• DTCA is free speech and is protected by the U.S.
  Constitution

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Arguments against DTC Advertising

• DTCA raises health care costs by stimulating
  consumers to demand more expensive new drugs and
  products (e.g.. Celebrex at 188/mo. vs.
  ibuprofen at 18/mo.)
• Pressure from patients erodes physicians
  authority and may lead to inappropriate
  prescribing
• Ads may be misleading and promote inappropriate
  use. Education should not be left primarily to
  private companies promoting their products.

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Arguments against DTC Advertising

• The FDA should require a waiting period of two
  years from the time a drug is approved until the
  drug can be promoted throuugh DTCA
• Advertising leads to early heavy use of new drugs
  before their long term safety has been
  ascertained (e.g., VIOXX,HRT)
• Among the 10 drugs most heavily advertised to
  consumers, many are deemed less essential
  medications by the WHO.

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Concerns

• Pharmaceutical and biotechnology companies are
  having an increasing impact on what is considered
  normal or pathological. This is worrisome since
  these companies are primarily responsible to
  their shareholders and not to their patients.
  Shareholder desires are frequently at odds with
  patients' needs.
• The U.S. health care system has been reshaped
  from an enterprise focused on the health of the
  people to just another market place like fast
  food prducts, automobiles, etc.

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Engines that Drive Medicalization

• Biotechnology
• Consumers
• Managed Care

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