Prescription Drug Advertising: Has It Gone Too Far?

It seems like only yesterday there was no such thing as prescription drug advertising. And now, there’s no escaping it.

In fact, TV drug ads are so common in the U.S., it’s hard to believe that only two countries in the world allow them: the United States and New Zealand.

To see just how far American pharmaceutical companies have fallen down the rabbit hole, let’s consider AstraZeneca’s TV ads for Movantik. This drug is used to treat an opioid side effect — namely, constipation.

That’s right. In the midst of a national health crisis — overdose deaths due to opioids — AstraZeneca has chosen to cash in on an apparently common side effect of opoiod pain meds: “opioid-induced constipation” (or OIC).

Let’s see if we can figure out how this all came about…

How Did We Get Here?

Before 1980, drug companies advertised only to the medical community. Direct-to-Consumer Advertising (DTCA) simply did not exist.

Then in 1981, a few drug companies began testing the waters. The Food and Drug Administration reacted swiftly with a moratorium on ads, to allow research on the matter. The moratorium was lifted after a few years, but only to allow print drug advertising.

It took more than 14 years before TV advertising really caught on.

Why’s that? Because of the fine print. Specifically, the prescribing information which accompanies the medication. (You know, the paper insert which unfolds to the size of hand towel.)

The FDA would not allow TV drug advertising which did not include the “fine print.” Specifically, the ads had to list:

Who should not take the drug
When the drug should not be taken
Possible serious side effects of the drug and, if known, what can be done to lower the chance of having them
Frequently occurring, but not necessarily serious, side effects

The FDA calls this list the “brief summary,” meaning it’s just the prescribing information basics.

In addition, in the early days, a product could be advertised on TV only if:

The ad presented both the brand and generic names for the drug, and more importantly
There was no representation of what the drug was for.

Which is why the earliest drug commercials were very brief and rather strange.

The Earliest TV Ads

For instance, some of the early ads for Rogaine simply stated, “Did you know that Rogaine was minoxidil?” or “I didn’t know that minoxidil was Rogaine.” Huh? Unless you already knew what Rogaine was, this ad made no sense.

On May 19, 1983, a commercial for the pain reliever Rufen (i.e., ibuprofen) aired. It was produced by Boots Pharmaceuticals, and it lasted all of 22 seconds:

Within two days, the FDA sent a cease-and-desist letter to the drug maker to stop airing the ad. Surprisingly, most drug manufacturers at the time agreed that direct-to-consumer drug advertising was a bad idea. (An Eli Lilly executive called it “both unwise and inappropriate.”)

It would be another decade before many of them would even consider it.

Relaxed Restrictions

Fast forward to the mid-90’s. Schering-Plough decides to take a leap with its Claritin commercial. Before you know it, the FDA begins relaxing its rules.

Drug advertisers now had a choice. They could either include the “brief summary,” OR their TV ads must have four components:

A toll-free number for viewers to call to obtain the drug’s prescribing information
A reference to a magazine where the drug company was concurrently running a print ad (so viewers could read the prescribing information)
A website where the prescribing information could be found, and lastly
Instructions to “ask your doctor or pharmacist” for more complete information

It seems that most drug companies have opted for the brief summary. Which is why the average drug commercial today lasts about a full minute. And includes a seemingly endless litany of side effects.

Once the pharmaceutical companies began jumping on board the TV-ad gravy train, there was no going back. By 1998, U.S. drug companies were spending $1.3 billion on advertising. By 2016, that figure had increased to $5.2 billion, the bulk of which was television advertising.

Back to the Movantik Plug

Which brings us back to the Movantik ad which has caused such an uproar.

Shortly after the commercial first ran during the 2016 Super Bowl, Vermont Governor Peter Shumlin called on AstraZeneca pull the ad, which he called a “shameful attempt” to exploit the opioid crisis. Gov. Shumlin stated that the drug advertising money should instead be used “to fund opiate and heroin prevention and treatment programs.” A spokesman for the governor elaborated: “At a time when the entire country is battling an opiate and heroin epidemic, the last thing we need is for drug companies to take advantage of that crisis to boost their bottom line.”

In a letter to the company, the Democratic governor further explained his position:

The irrational exuberance with which opiates are handed out in America is driving the addiction crisis in this country. Now is the time to change that, not attempt to further normalize long-term opiate use by advertising a drug to help people take even more opiates.

Denis McDonough, the former White House chief of staff, also was not amused. “Next year, how about fewer ads that fuel opioid addiction and more on access to treatment?” he tweeted.

The Defensive Position

Of course, the pharmaceutical companies would beg to differ. AstraZeneca’s position is that OIC is a huge problem among opioid users and must be addressed. In one of their surveys, 77% of respondents indicated that it was a problem “people are ashamed or embarrassed to talk about.”

According to Claire Gibson, an analyst for the research and consulting firm GlobalData, “It’s really crucial for companies that are developing these drugs to inform patients and physicians that these drugs are available, and drive patients to their physicians’ office.”

Really?

But wouldn’t the more obvious solution be to stop using so many opioids? Of course, we now know that these drugs are highly addictive, and stopping can cause serious withdrawal symptoms. (See related article, “History of Opioids: From the Joy Plant to ‘Just Say No.’“) But do we really need a pill to solve a problem caused by other pills?

Where does it end?

An interesting side note about the Movantik ad is that it failed to mention the possible side effects: Abdominal pain, nausea, gas, vomiting, headache, excessive sweating, excessive flatulence and diarrhea. Ironically, these side effects are remarkably similar to opioid withdrawal.

But don’t worry… there’s a pill for that.

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