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

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.

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