The Price of Drugs
I recently wrote an article on the drug Sarafem and the way its manufacturer Eli Lilly has marketed it. As mentioned in the article this is but one drug that has been widely advertised due to the Food and Drug Administration opening up the regulations regarding drug advertisements.
This issue has been covered recently in an article in Mother Jones magazine (April 2001), in which a number of widely used drugs have become extremely popular and profitable directly as a result of widespread advertising. The article states that pharmaceutical companies spent an estimated $1.7 billion on TV advertising in 200, 50% more than in 1999, more than double the 1998 amount. In 1991, only one brand of prescription medication was marketed on network television. By the end of 1997, there were 12 drugs, and by 2000, there were at least 50. The USA is now one of only two countries in the world (New Zealand being the other) where prescription drugs are hawked in prime time.
Advocates of the new open advertising policy say it helps educate the public. Critics say it creates more business for pharmaceutical companies and encourages the use of expensive, potentially dangerous drugs. There may be truth to both positions but a question has been raised by this situation. The USA already consumes more prescription drugs per person than any other nation. Will this form of advertising only encourage even more consumption and put even more pressure on the health care system to pay for expensive and at times unnecessary drugs?
But will it also help encourage patients take a more active and responsible role for seeking solutions to their health problems, creating a well- informed population. Whilst few people would not want to know all the options for their health concerns, the threat may lie in the fact that drug companies are only going to invest money in products in which they can make a profitable return on. They will always tend to focus on a chemical solution to problems in which there may be easier, cheaper and more natural alternatives, ones that will never get the kind of airplay of pharmaceutical drugs. On the other hand, the article states that it is true that many people are sicker than they think and if advertising stimulates interest in their health, more conditions may be able to be diagnosed.
The bottom line though is the dollar. The article quotes that after spending nearly $80 million on Prilosec advertising in 1999 (up from $50 million in 1998), AstraZeneca saw sales rise 27%, to $3.8 billion. Pfizer, advertising its cholesterol drug Lipitor, spent more than $45 million in 1999, and sales of the drug rose to $2.7 billion. Other categories of drugs, which have seen huge increase in profits, are the allergy drugs such as Claritin, Zyrtec and Aventis. Increase in advertising saw a huge increase in sales, by up to 50%. Did the number of allergy sufferers increase to the same amount during that time. Apparently not, it states in the article.
The goal of direct advertising is to get patients to demand specific medications from doctors, who are more likely to give what the patient wants. A FDA survey revealed that of those who asked for a specific drug by name, nearly half were given a prescription for it.
One popular form of drugs has been the cholesterol lowering drugs such as Lipitor, Pravachol and Zocor. Anyone who watches any TV will have seen these ads of middle age, middle class people driving to their doctors and coming out smiling. However, if one listens to the voice on the ads, the last 10 seconds or more are devoted to the side effects of these medications, which can be quite serious. A critique of the increased use of these drugs is that it encourages taking a drug instead of initially trying to lower cholesterol through diet and exercise.
A more insidious advertisement has been that for Paxil, an anti-depressant more recently marketed for social anxiety disorder. The advertisements give the impression that it can be taken for just about all forms of anxiety. Again, it can be seen to only encourage the taking of a pill for every conceivable difficult situation, as apposed to definite clinical conditions.
Another popular new drug on the block is the arthritis medication, Celebrex. However, the adverts for the drug were criticized for being misleading and after a FDA review, the makers of the drug slightly modified their advert. Celebrex and Vioxx are different from previous similar medications in that they do not have the same gastrointestinal side effects. However, according to sources quoted in the article, the proportion of people at high risk for that side effect is between 10-20%, but they are now are being taken by up to 40% of arthritis patients. Therefore, many people are getting these medications who have no need for them, and this makes a big difference financially as Celebrex costs $900 a year in comparison to $24 for generic ibuprofen. This increase in prescription drugs is leading health organizations to predict a 15% increase in prescription drug costs through 2004.
As we look for ways to dealing with spiraling costs of medical care, and the social impact of a nation taking more medications than ever before, the increase in drug advertising raises serious questions as to its economic and social effect on our society. Pharmaceutical organizations are some of the most powerful economic forces in the world, and whilst some of the medications they produce save lives, there has to be some balance in the way in which drugs are marketed and distributed so we can have a society truly healthier and not just dependent on ever increasing amounts of medications to deal with every problem.