This Is America. This Is America on Drugs

Ask your doctor if Cialis is right for you

Imagine spending billions of dollars a year to advertise a product to a group of people who aren’t even authorized to buy it. Sounds pretty crazy right? Well not if you’re a pharmaceutical company.  Thanks to lax laws that make the United States one out of only two countries in the world (New Zealand is the other) where prescription drug makers are allowed to hawk their products directly to consumers on television and radio, the airwaves are chock-full of little green butterflies (Lunesta), smooth-talking bumblebees (Nasonex), and middle-aged hunks who can’t get it up (Cialis, Viagra, Levitra) all working toward one goal: convincing you that you’ll be healthier, happier, sexier, if you can just get your doctor to write you a prescription.

In case you haven’t noticed, there are an awful lot of drugs on TV these days. You can hardly turn on the tube without a soothing voice telling you about the latest slickly packaged miracle remedy followed by a laundry list of often contradictory side effects (drowsiness and insomnia? What’s up with that?).

Since the 1940s, most countries have banned the marketing of prescription medication directly to consumers, and even here in America, such ads were nonexistent until the 1980s (hard to believe, right?). Prior to that, drug companies got their products out by wooing doctors with free samples and—as anyone who has ever worked in a high-end restaurant can attest—expensive “informational” dinners (which they still do).

Then, in 1997, the Food and Drug Administration liberalized the regulations surrounding the marketing of pharmaceuticals to consumers—requiring companies to reveal only the most serious side effects—and it was off to the races.

Statistics show the prevalence of direct-to-consumer drug ads skyrocketed more than 300 percent in the decade following the change, and by 1999 the average American was being exposed to nine televised ads for prescription drugs every day. And it’s only gotten worse. A 2007 content analysis published in the Annals of Family Medicine under the title “Creating Demand for Prescription Drugs” determined that Americans watch 16 hours a year of televised pharmaceutical ads, while Nielsen now estimates that on any given day 80 drug ads every hour are running across America’s TV sets.

So what’s going on here? Why are drug makers so intent on repeatedly trumpeting the benefits of the same handful of medications? It’s simple: Big Pharma is big business.

The pharmaceutical industry has been among the top three most profitable sectors almost every year since 1995, and Americans now spend $300 billion a year on prescription drugs, more than any other country and more than six times what we spent two decades ago.

Are we just sicker? Not likely. But the industry would like us to think we are.

Here’s why: With 13 of the industry’s top-selling drugs set to come off patent by 2013—making them susceptible to generic competition—and Wall Street souring on research and development into new drugs, the industry needs to make the most of the products it has, and that’s where you and I come in. With the average brand-name prescription now costing more than $120 to fill, the value proposition is crystal clear. It doesn’t take a financial analyst to do that math.

The industry has a number of less-than-ethical methods for getting us to buy more brand-name medicine, such as off-label marketing—where a drug that has been approved for one ailment is illegally promoted for others—kickbacks to doctors, and paying rivals to keep generics off market through deals known as pay-for-delay (see my article on this practice at The American Prospect).

Such activities cost the U.S. taxpayer and consumers millions of dollars every year, and the FBI’s Financial Crimes Unit calls pharmaceutical fraud one of its “top three threats.” Between 2008 and 2010, the government sued six of the top 10 drug companies, including Pfizer, Merck and Eli Lilly, for fraudulent practices like off-label marketing; and according to the website FinFacts, leading pharmaceuticals have paid a total of more than $20 billion in fines since 2006 to settle allegations of fraud and kickbacks—some of the largest payouts in history. For an industry in which the top 10 players rake in a combined total of more than $35 billion a year in profits, that’s just the cost of doing business.

But by far the most effort goes to good old-fashioned advertising.

Data shows that Big Pharma spends more than $4.5 billion a year marketing its wares to consumers, twice as much as it spends on research and development. After all, why make new stuff when you can profit from the old? The strategy seems to be working: Doctors write nine times as many prescriptions for advertised drugs than non-advertised ones, according to the Congressional Budget Office, and patients are twice as likely to ask their doctors about a specific drug after seeing it on TV.

But then again, isn’t the whole point of advertising to sell products? When it comes to potentially life-saving medications, not everyone thinks so. As Dr. Dominick L. Frosch, a co-author of “Creating Demand for Prescription Drugs” explains:

“Our findings suggest the need to reconsider the distinction between selling soap or other consumer products and selling prescription drugs. Poor judgment among soap brands may have few health consequences; direct to consumer advertising’s influence on drug preferences and the resultant importuning of physicians to prescribe cost-ineffective (or even inappropriate) drugs are a much more substantial concern for health care expenditures and population health.”

Yet deceptive advertising isn’t just about selling drugs, it’s about selling the diseases they treat. In their 2005 book “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients,” journalist Ray Moynihan and Alan Cassels, a pharmaceutical policy researcher, show how the drug industry works to create new ailments by underwriting disease research.

“Many of the senior specialists deciding whether your sexual difficulties should be defined as sexual dysfunctions, whether your stomach complaints should be seen as serious medical conditions, and whether your everyday risks should be portrayed as deadly diseases, are on the payrolls of the companies seeking to sell you drugs,” they write.

Journalist Lynn Payer—who died of breast cancer in 2001—had a name for this:

Disease-mongering —trying to convince essentially well people that they are sick, or slightly sick people that they are very ill—is big business,” she wrote. “Disease-mongering is the most insidious of the various forms that medical advertising, so-called medical education, and information and medical diagnosis can take.”

A survey of the healthcare industry confirms that the scare tactics have been wildly successful for Big Pharma. While Americans account for just 5 percent of the world’s population, we now consume more than half of its prescription drugs. A quarter of Americans over the age of 45 take cholesterol-lowering statin drugs like Lipitor, which, much to Pfizer’s chagrin went off patent this week, while the average adult under 65 now fills 12 scripts a year, five more than they did in 1992.

I personally take just one: a beta blocker for elevated blood pressure that I was unable to control through my exercise routine. It was suggested to me by my doctor, not a television commercial. I’m grateful to say I’ve never suffered from erectile dysfunction, and while I have a tendency to get a little antsy in long lines and have been known to lose my shit in traffic, I’m pretty certain that I don’t have adult attention deficit disorder; but in the event I should ever find myself inexplicably flaccid or climbing the proverbial walls with unfocused energy, I doubt I’ll have to look very far for a suggested remedy.