Over-Medicating America

There is an important study in this month’s issue of the Annals of Family Medicine It concerns something that most health care professional in the United States have been worried about for some time: it is direct-to-consumer advertising of prescription medicines. I rarely watch much television, but out of interest I had one channel on for an hour this morning and saw six advertisements for medicines. It is not widely known that this practice is illegal in most of the rest of the world, with the exception of New Zealand.

The research suggests that this direct-to-consumer television advertising of prescription drugs may be influencing Americans to believe that they are sicker than they really are. This may in turn lead to taking more medication than they actually need.

The study was funded by the National Cancer Institute’s Centers of Excellence in Cancer Communication Research and the Robert Wood Johnson Foundation, and was led by Dominick Frosch from the David Geffen School of Medicine at the University of California, Los Angeles.

The researchers evaluated the educational value of 38 direct-to-consumer television advertisements for prescription drugs and analyzed how they tried to influence viewers. The drugs in question were for treating illnesses ranging insomnia and depression to high cholesterol and high blood pressure.

Their findings suggest that the advertisements had virtually no educational value. Furthermore they failed to describe who is most at risk for which illnesses, what their symptoms might be, and whether non-medicinal alternatives such as lifestyle changes might also be viable options.

According to the figures cited, Americans watch up to 16 hours of television advertising about prescription drugs per week. The scientists watched the advertisements shown during the evening news and prime time periods. They used a coding system that takes into account a number of attributes of each ad. The attributes included the factual claims made about the illness the drug is aimed at, the method used to attract the consumer, and also what is revealed about the behavior and lifestyle of the people in the advertisement.

Although they found that over 80% of the advertisements did make some factual claims and put forward rational arguments for use of the drugs, only 25-26 per cent of them described symptoms and causes of illnesses, the associated risk factors and how common or rare they are.

The scientists also found some common strategies: many of the advertisements portrayed the drugs in terms of people losing control over their lives (58%) and then regaining it (85%) once they took the medication. 78% of the ads also portrayed the medication as engendering social approval, while 58% of them implied that the drug was a medical breakthrough.

The findings also show that nearly all advertisements (95%) used emotional appeal to influence viewers and none of them showed lifestyle and behavior change as viable alternatives, except for 19% of them that showed this as an adjunct to taking the drug. 18% of the advertisements suggested that changes to lifestyle would not be enough to deal with the illness.

The conclusion of the study is that despite the claims that television advertisements play an educational role, they contain limited information about causes and symptoms of their target illnesses, their prevalence and risk factors. They also show people that have “lost control over their social, emotional or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.”

Dr Frosch said that “We’re seeing a dramatization of
health problems that many people used to manage without prescription
drugs,” and that the “ads send the message that you need drugs to
manage these problems and that without medication your life will be
less enjoyable, more painful and maybe even out of control.” He said
that the US should consider banning direct to consumer television
advertising of prescription drugs too. Something that was echoed in the
accompanying editorials.

I have spent a great deal of time weighing the pros and cons of direct-to-patient advertising with health care professionals and people in the pharmaceutical industry in Europe, the United States and Australia and New Zealand. Despite all of our work to empower people, I remain unconvinced that they are ultimately in peoples’ best interests.