The great direct-to-consumer prescription drug advertising con: how patients and doctors alike are easily influenced to demand dangerous drugs

Staying informed is tough these days.  What is sad is when an industry takes advantage of this to mislead the very people they are supposed to be helping.  Well, unfortunately the drug companies are doing this very thing.  "Medical" drug usage has increased exponentially in the last 10 years without any decrease in mortality rate in this country.  Knowing this fact, the drug companies have not looked for better solutions, but rather have doubled their efforts to push as many drugs to the market before their bad side effects are seen.  Check out this article on some of the tactics used to sell dangerous drugs to you the public. 


A cute, animated ball bounces around very sadly until he takes a magic potion; suddenly, it becomes happier than ever. No, that isn't the plot of a new children's movie. On the contrary, it's the storyline of a Zoloft commercial – yes, Zoloft, a powerful antidepressant drug. In the 1990s, direct-to-consumer advertising like this increased at a compounded-annually rate of 30 percent, according to Ian Morrison's book, Health Care in the New Millennium. In fact, by 1995, drug companies had tripled the amount of money they formerly allotted to consumer-directed advertising, writes to Gary Null in Death by Medicine. Since then, pharmaceutical advertising has grown to an entirely new, pop culture-savvy level.

These days, it's hard to tell the difference between pharmaceutical commercials and car commercials. Both are almost always intended to look "cool." Car and pharmaceutical commercials use the same hooks -- popular music, good acting and lofty promises -- to hook consumers and reel them in. Falling prey to car commercials results in little more than hefty car payments; however, becoming seduced by pharmaceutical companies can result in the consumer willingly taking powerful drugs, at the risk of serious illness and even death. In spite of this tremendous risk, pharmaceutical advertisements are becoming increasingly common and, unfortunately, increasingly effective. In 2000, pharmaceutical companies spent $2.5 billion on mass media pharmaceutical advertisements, according to Mike Fillon in Ephedra: Fact or Fiction. This number increased to over $3 billion in 2003, according to Dr. John Abramson's book Overdosed America. In his book, Death by Prescription, Ray D. Strand looks at these high figures and poses the question: "Why?" Why do pharmaceutical companies spend billions of dollars on direct-to-consumer advertising, when consumers can only obtain prescriptions for these drugs through a doctor? Wouldn't it seem that consumers have no influence whatsoever on the success of a prescription drug, so advertising should be directed entirely toward doctors?  That makes sense, but it's not the way things work. Pharmaceutical companies wouldn't spend billions of dollars on direct-to-consumer advertising if it didn't work. In fact, the advertisements are working … too well. Fillon writes, "The average number of prescriptions per person in the United States increased from 7.3 in 1992 to 10.4 in 2000. Along with this increase in demand, there has been a shift towards the use of more expensive medications. It's more than a coincidence that many of the most expensive medications happen to be those medications that are most heavily advertised." In fact, between 1999 and 2000, prescriptions for the 50 most heavily advertised drugs rose six times faster than prescriptions for all other drugs, according to Katharine Greider's book, The Big Fix. So, how is direct-to-consumer advertising so effective in a system in which doctors write out the prescriptions?

Telling clever stories with misleading ads

Well, first, let's explore direct-to-consumer advertising, namely the television commercial. Most prescription drug commercials follow the same script progression: First, the commercial shows how bleak life was for a person or character before taking whatever prescription medicine the commercial is advertising. Then, the protagonist demonstrates or tells how wonderful life is while on the drug. Finally, a voiceover obligingly lists the side effects, often speaking as quickly and inaudibly as possible.

Take, for example, a Paxil commercial that was recently popular. At the beginning of the commercial, the typical 30-something-year-old woman is standing outside a house, looking through the window at the happy party going on inside. She looks so lonely and depressed that it must break nearly every consumer's heart. "What's wrong with her?" we compassionate humans gasp in unison. The voiceover answers our question as we think it: The woman has social anxiety disorder, a condition that can be treated with the prescription drug Paxil.  Suddenly, the now-medicated woman rings the doorbell and, with a huge smile on her face, joins the party. We see how much fun she is having and we are so happy for her! Of course, the voiceover quickly goes through the list of Paxil's potential side effects, but how can we concentrate on that, when we're so busy rejoicing at the woman's new happiness? Whoever wrote that commercial should write Hallmark movies. After seeing it a few times, I was convinced that most of my non-immediate family had social anxiety disorder and I even called one relative up to suggest that she take Paxil. I'm not even a gullible person, yet I was persuaded by pharmaceutical company advertising.

Doctors prescribe whatever the patient names

We are what Strand calls a "self-medicated" society. Consumers do not actually write their own prescriptions, but they practically do, based on whatever drugs they see advertised on television. Strand writes, "Surveys reported in our medical literature reveal that when a patient comes into a doctor's office and requests a specific drug that he has seen advertised in the media, the doctor writes the exact prescription the patient requested more than 70 percent of the time!"

So, let's say that a consumer who has been feeling a little sad lately sees a commercial for the antidepressant drug Zoloft. The commercial demonstrates the symptoms for depression and the consumer identifies with them. Suddenly, he or she thinks, "I'm not just sad. I'm depressed, which is a 'medical condition that can be treated by the prescription drug Zoloft.'" With this in mind, the consumer goes to a medical doctor and says, "I've been really depressed a lot lately. I've been [the consumer recites the depression symptoms listed in the Zoloft commercial]. I think I need Zoloft." So, according to Strand, there's a 70 percent chance the doctor will prescribe Zoloft, the exact prescription the consumer requested. That's how pharmaceutical commercials really work. They directly influence consumer behavior, yet drug companies claim they only "educate" patients, but don't persuade them to do anything.

Doctors are easy to manipulate, drug companies discover

You may be wondering why doctors base their prescriptions on the requests of their patients, who usually have no medical training whatsoever. That's a good question with a simple answer. The pharmaceutical-advertising machine seduces doctors, too.

According to Burton Goldberg's book, Alternative Medicine, paid pharmaceutical advertisements are the main source of the Journal of the American Medical Association's revenues. The American Psychological Association is equally under the pharmaceutical companies' spell, as 15 to 20 percent of the American Psychological Association's (APA) income comes from pharmaceutical advertisements in its journals.  In Innocent Casualties, Elaine Feuer calls these advertisements "intentionally misleading" because they promote the pharmaceutical by "exaggerating a drug's benefits while downplaying its hazards in small print in the addendum." This is very similar to the obligatory "side effects" voiceover recited at the end of a pharmaceutical television commercial; neither consumers nor doctors pay much notice to the "final voiceover" or "fine print."  Just in case advertisements in the Journal of the American Medical Association (JAMA) haven't properly seduced doctors, pharmaceutical companies take an extra promotional step by aggressively "detailing" doctors, which involves promoting drugs through door-to-door giveaways of free information and samples, according to Health Care in the New Millennium. Morrison writes that "Pfizer alone has 4,500 people in its sales force," but these employees' salaries are small change compared to the increased revenue they encourage.  The next time you watch television or read a magazine, pay special attention to pharmaceutical advertisements. Notice their promotional hooks and be grateful that you, unlike most consumers, are no longer susceptible to their influence. That's what knowledge, unlike naiveté, brings you.


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