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By Alan Cassels
Travelling to the U.S. never fails to put me in touch with a part of American culture that I find particularly fascinating, but disturbing. Drugs. Drugs and more drugs. I’m talking about the in-your-face, 24/7, marketing of the newest, most expensive pharmaceuticals on the planet.
All in the name of health, of course.
You might argue, but so what? Every other consumer product gets advertised in the U.S. — almost everywhere, to everyone, perhaps except tobacco. And lots of those things are bad for you too, such as junk food, alcohol and gambling.
However, drugs are different, and I often find myself experiencing a kind of vertigo as I stare, enthralled, at all the incessant drug advertising from screens everywhere I look — in airports, hotel lounges, restaurants or bars.
The plotlines are predictable. A slick 60 seconds and we see the fate of worried people suffering some sort of condition, “ask their doctor” about drug X, and soon the new prescription is magically transforming their lives.
They turn into bliss and smiles as they romp their way through meadows of wildflowers while, sotto voce, we catch strange murmurs of liver failure and premature death.
I find myself absorbed in the ads as if they are cultural artifacts of a strange race. Most of the Americans I know seem to be pretty healthy people, but any newcomer confronting all the U.S. screens for the first time might conclude one thing: “Man, these people must be really sick.”
They are sick, but not in the way of being physically sick. Sick as in showing all the adverse effects of living in a polluted information ecosystem where toxic levels of drug propaganda drift through the airwaves as freely as exhaust engulfs a freeway.
Americans are so immersed in the smog of commercially-sponsored drug information that they might forget they used to live in a world where serious criticisms of drug industry products or behaviour were routinely reported on mainstream TV. Those halcyon days are over.
The Land of the Free means drugmakers can, with near impunity, push their expensive products for Crohn’s disease, Colitis or psoriasis — serious obesity, schizophrenia and major depression with the most outlandish of claims wrapped up in crafty but misleading narratives.
Drugs get advertised, and the stuff between the ads (ie: the programming, the sitcoms and the news) won’t touch the subject with a 10-foot pole lest they upset the money chain. Meanwhile, everyone thinks this is normal? Wow.
Not everyone. Earlier this summer, the consumer group U.S. Public Citizen put out a petition urging the U.S. Food and Drug Administration (FDA) to ban direct-to-consumer advertising (DTCA) of prescription drugs.
They listed the usual reasons why DTCA is so toxic to consumers: emotional manipulation, misleading benefit and risk information, inappropriate prescribing and overdiagnosis, the erosion of the patient-physician relationship, the promotion of low-value medications and overall economic harm. Amen to all that.
What it all adds up to is a polluted environment in which careful and appropriate pharmaceutical use doesn’t happen. Americans are paying the highest prices for prescription drugs in the world, yet also have the most profligate use of those drugs.
The pollution of the airwaves by Pharma propaganda is precisely the reason every other country in the world (except tiny New Zealand) bans DTCA. The rest of the civilized world looked at DTCA, recognized it as a predatory assault on public health, and banned it decades ago.
DTCA and the doctor-patient relationship
Probably the biggest harm of DTCA is how it completely undermines the clinical firewall between doctors and patients. By bombarding television viewers with slick, emotion-heavy commercials, drug manufacturers bypass the doctor’s intellect and go straight for the patient’s anxiety.
When a terrified or hopeful consumer marches into a clinic demanding a specific brand-name drug featured during halftime at a football game, the doctor-patient relationship is fundamentally hijacked. Your physician stops being a healer weighing evidence and becomes a drive-thru cashier being pressured to hand over the order.
Drug ads are veritable master classes in how to exaggerate the severity of a condition, extoll the benefits of a product, downplay the harms and plant the “Ask your doctor” message. And thus, the drug ad drives a wedge into a relationship that should be about healing, and not about dealing.
The plain fact is this: prescription drugs are not breakfast cereals. You cannot walk into a pharmacy, grab a box of third-generation immunosuppressants off the shelf and toss them into your shopping cart alongside the peanut butter.
By law, prescription medications require a “learned intermediary” — a physician who has spent a decade in medical training to weigh complex evidence, harms, benefits and alternatives.
Many patients might believe that their own doctor can ignore the marketing pressures of the drug industry, yet they’d be mostly wrong.
Drug information or “continuing medical education” swallowed by our physicians is even more toxic because it’s usually wrapped in gifts along with the imprimatur of peer-reviewed publications.
Fact is, when it comes to pharmaceuticals, most doctors are not as “learned” as we’d like. This has to do with a well-studied cognitive bias where doctors generally believe they are too smart to be influenced by marketing.
This phenomenon has been well-studied and there’s even a term for it: the “illusion of invulnerability.” This is when doctors acknowledge that pharmaceutical marketing and gifts influence the prescribing habits of other doctors, yet believe that they themselves are immune to that same psychological manipulation.
We know that drug marketing is bad for consumers, but just this week we found some serious proof about how bad it is for our doctors.
A Cochrane review published this week looked at 93 studies — most from the U.S. but also from France, the Netherlands, Denmark, Germany, Sweden and the U.K. and found that the more exposure physicians have to the drug marketers, the worse their prescribing is.
We’ve known this for decades, yet the grift continues and the poor doctor-patient relationship is bombarded with DTCA on one side, and by the inducements and gifts provided by pharmaceutical companies.
There is a very good reason that Robert F. Kennedy Jr., the U.S. secretary of Health and Human Services, has wanted to ban drug advertising. He knows that the medications are being flogged by the most highly paid marketers on earth whose job it is to create these brazen vignettes of triumph to get you to “Ask your doctor.”
The way I see it, if a drug company is telling you to “Ask your doctor!” you can be sure the company’s people have already seen your doctor and he or she is fully aware of the drug in question.
Any drug that is advertised to patients directly is also going to have a substantial marketing campaign targeting the doctors because they’re the ones who are writing the prescriptions.
If you consider the body of the most highly advertised drugs these days, you might be led to think there certainly must be an epidemic of psoriasis, Crohn’s disease or ulcerative colitis in the U.S.
Maybe that is explained by high-grade hawking of Skyrizi, Tremfya and Rinvoq, three drugs which have the biggest direct-to-consumer television ad spending across the entire U.S. pharmaceutical industry (according to Forbes), each spending more than $350 million a year.
The reality is that these companies are vying hard for a slice of the pie, and their incredibly high profit margins (due to patents) and the malleability of consumers make these new drugs worthy of advertising, even if the diseases in question affect very few people.
For example, psoriasis only affects about 3% of the U.S. adult population, and Crohn’s disease or Colitis about 1%. Together, nearly $1 billion a year is spent flogging products that might only affect 10 million out of a national population of 340 million people.
Getting rid of DTCA in the U.S. is a big ask, and doing so probably requires some reworking of the U.S. Constitution. Kennedy has already felt the pushback, not just from the drug companies, but from the media outlets that depend on drug advertising.
If ever there was a reason why Americans should rethink the wisdom of the First Amendment, it is in how it is applied to drug companies.
Sure, we all want to have freedom of speech, freedom of the press, of religion and of peaceful assembly, but can anyone say the drug companies are using their freedoms of expression responsibly?
A case study in DTCA
Let’s end with what I think is the poster child of modern pharmaceutical hubris and marketing wizardry, and a teachable lesson why we should seriously restrict DTCA in the U.S.: Veozah (fezolinetant).
During Super Bowl LVIII in February 2024, the maker of this new drug, Astellas Pharma, dropped a small fortune to air a glossy, 60-second commercial titled “Fewer Hot Flashes, More Not Flashes.”
The target? Menopause — a completely normal, universal biological transition that the pharmaceutical complex has been trying to rebrand as a deficiency disease for over half a century.
The commercial promised women a revolutionary, non-hormonal fix for vasomotor symptoms. It was upbeat, empowering, and utterly seductive.
Fast forward seven months, to September 2024.
The FDA issued an urgent safety warning: Veozah can cause severe, potentially life-threatening liver injury and liver failure. The FDA mandated new blood testing protocols before and during treatment because patients were ending up with signs of serious liver damage.
Think about the sheer, unadulterated madness of this sequence.
A pharmaceutical company uses the biggest, most expensive advertising platform on planet Earth to sell an expensive, brand-new pill for a normal life transition to millions of healthy women.
Seven months later, the regulatory body is forced to admit that this heavily hyped, premium-priced drug can literally wreck your liver.
This is the toxic life cycle of DTCA in a nutshell: hype the symptom, brand the condition, air the Super Bowl ad, collect the billions and wait for the safety warnings to roll in after the real-world guinea pigs start getting hurt.
If there were an international award for the most psychologically manipulative, disease-mongering phrase ever foisted upon the public, “Ask your doctor if [drug X] is right for you” would win by a landslide.
It sounds so innocent, doesn’t it?
A gentle nudge encouraging patients to take charge of their health. Not quite. It is a multi-billion-dollar marketing trick designed to erode your agency, medicalize the ordinary discomforts of being human, and turn you into an unpaid sales representative for Big Pharma.
Nobody spends $7 million airing a Super Bowl commercial for a generic, off-patent $5 diuretic that actually saves lives.
DTCA exists exclusively to pump up the sales of ultra-expensive, newly patented drugs that need to recoup their marketing budgets before their patents expire.
It is time to end this absurd experiment once and for all. Prescription drugs should be evaluated on hard clinical evidence by independent professionals, not sold like soft drinks to a captive, frightened audience.
“Ask your doctor” shouldn’t be a tagline on television — it should be a private conversation free from the polluting influence of Super Bowl commercials.
Originally published by Brownstone Institute.
Alan Cassels is a Brownstone fellow and a drug policy researcher and author who has written extensively about disease mongering.
