The following originally appeared on The Upshot (copyright 2016, The New York Times Company).
If you’ve watched any television, you’ve seen drug ads — a lot of them. Drug companies spend several billion dollars a year on direct-to-consumer advertising. Count them and there are 80 drug ads an hour.
Do drug ads provide useful information, as the pharmaceutical industry maintains? Or do ads just promote wasteful use of expensive new drugs, justifying regulation to rein them in? Those questions have taken on new importance as spending on drug ads has grown. Gilead Sciences, for example, spent $100 million on an ad campaign for its hepatitis C drug, Harvoni — the one that costs as much as $1,100 a pill.
Americans are about evenly split on the educational value of prescription drug ads. But the American Medical Association recently called for a ban, arguing that TV drug ads merely drive demand for expensive treatments. Senator Al Franken, making the same argument as the A.M.A., has introduced a bill to withdraw tax breaks companies are permitted to take for their ad spending.
Research on the consequences of drug ads presents a more nuanced picture. Advertising increases drug sales; the studies are consistent on that. It does so for the promoted drug, as one would expect. But it also increases sales of other, nonadvertised drugs for the same condition. For instance, Prozac ads lead to increases in prescriptions not only of Prozac, but also of Zoloft. Bradley Shapiro, an economist at the University of Chicago, found that the increase in the overall antidepressant market is larger than the market share gains made by just the advertised drugs.
Why would one drug benefit from another’s ads? For stigmatized conditions, like depression and other mental illnesses, drug ads may serve to normalize them, encouraging sufferers to seek treatment, even if it’s not with the specific advertised drug.
Doctors appear to benefit from TV drug advertising. Only they, and certain types of nurses, can prescribe drugs, so for advertising to increase their use, visits to physicians must increase. And that’s what studies have found. One-third of adults said that drug advertising prompted a discussion with their physician. Collectively, every $28 spent by drug companies per year on ads resulted in one more visit to a doctor that led to a prescription. One more person making one more doctor visit doesn’t sound like much, but drug companies spend billions on advertising.
Interestingly, the A.M.A.’s call for an advertising ban does not extend to promotion aimed at doctors. Yet the drug industry spends about seven times more on visits to doctors’ offices by drug company representatives, free samples and advertising in professional journals than on ads directed at consumers. Physicians may more readily prescribe drugs they’re familiar with through these types of promotion.
Though doctors often may yield to patients’ requests for a specific drug, in many cases they apply their own judgment and prescribe a different one, or none at all. When it comes to depression, a randomized controlled trialshowed that drug requests led to more appropriate care, though not always with pharmaceuticals. The study sent professional actors to doctors’ offices, where they pretended to have depression. Among those who did not request drugs, only 56 percent received appropriate care — any combination of an antidepressant prescription, a referral to a mental health professional or a follow-up appointment. Just one-quarter of the people requesting a specific drug received it; about half received no drug at all. But among those who requested a specific drug, 90 percent received appropriate care, but not all of it involved drugs.
Another way drug ads can help patients is by encouraging them to continue with medication they’ve already been prescribed. According to one study, for every 10 percent increase in viewership of drug ads, between 1 and 2.5 percent more people adhere to their prescribed drug regimen. Several studies of spending on ads for statin drugs found that it was associated with a greater proportion of high-cholesterol patients who successfully brought their cholesterol levels under control.
Whether drug ads influence prescribing varies by condition. Ads for conditions that are easily tested — like high cholesterol or allergies — are more likely to lead to appropriate prescribing because there is little uncertainty as to whether the patient has the indicated condition.
One study showed that advertising leads to greater sales for drugs that insurance companies encourage via lower cost sharing. Another showed that advertising increases sales of lower-cost, nonadvertised drugs. Put it all together and the link between a drug ad and a patient obtaining that particular drug is weaker than many might think.
There’s little consistent evidence that ads substantially promote higher drug prices. One study found that only about 6 percent of the entire increase in prescription drug spending growth between 1994 and 2005 could be attributed to advertising-driven price increases.
It’s unlikely that all uses of prescription drugs that ads encourage are beneficial. One study found that greater advertising led to more adverse reactions to drugs. So some people propose a compromise position on drug ads: allow them only for drugs that have been in use for several years, during which time safety can be more thoroughly assessed. Another way to approach the problem might be to promote use of effective drugs byreducing their prices or patients’ out-of-pocket costs for them.
The evidence suggests that the A.M.A. is only partly right. Not all prescribing that drug ads promote is valuable, yet they encourage some helpful and appropriate care.