Sally Field is a talented actor. But what qualifies her to promote Boniva, an osteoporosis drug that is of limited benefit, has worrisome side effects, and for which there are natural alternatives that merit careful consideration?
In "What's Wrong with American Medicine?" I point out that many high-technology treatments have a shadow side. In most areas of life, technological development has made services better and cheaper, but (with a few notable exceptions) it has made health care worse and more expensive. The result: an unhealthy populace and an economy that's lurching toward disaster.
A major component of today's high-tech medical treatment is the reckless overuse of pharmaceutical drugs. An estimated 50 percent of Americans take at least one prescribed medication every day; in 2007, drug sales accounted for an astonishing $315 billion in revenue. When I was growing up, far fewer Americans took prescription drugs.
Direct-to-consumer (DTC) pharmaceutical marketing, such as Ms. Field's Boniva campaign, is a major engine behind this unfortunate change. American television, radio, internet and print are saturated with ads for every imaginable drug, typically ending with an entreaty to "ask your doctor." In 2004, American drug companies spent 24.4% of their sales revenue on promotion, versus just 13.4% for research and development.
Americans now accept these ads as a matter of course, but in my experience, visitors from other countries find them both amusing and appalling. As well they should: the United States and New Zealand are the only two developed countries that allow DTC advertising.
If this anomalous American phenomenon didn't work, it would indeed be merely amusing. Unfortunately, when you "ask your doctor," about a given drug, he or she is likely to hand over a prescription. In 2000, every $1 pharmaceutical companies spent on DTC advertising yielded an additional $4.20 in sales. This bewildering return on investment makes it easy to see why a quarter of drug company revenue is spent on advertising.
I worry about DTC ads for three reasons:
1. Drug ads strengthen our belief in pharmaceutical drugs as the cures for all of our problems. In fact, the consequences of poor lifestyle choices cannot be undone with pills.
2. Many advertised drugs are not only ineffective, but have serious side effects that are frequently played down (and occasionally concealed) by manufacturers. Because heavily advertised drugs have such vast profit potential, political and financial interests collude to speed them to market before they have received sufficient scientific scrutiny.
3. Ads circumvent better sources of information and make people believe that they are being proactive about their health when they request an advertised drug. Thirty-second TV spots that trade on emotion and celebrity contribute little or nothing of value to patient education.
The free market works well in many ways, but it has failed us here. Whether it is done independently or as part of an omnibus health care reform initiative, we need to make the same decision that the rest of the developed world has made: that is, ban direct-to-consumer advertising of prescription pharmaceutical products.
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