THOSE DARN DRUG ADS!

A few weeks ago, I published a blog about direct-to-consumer television advertisements (DCTA) for prescription drugs. The gist of the article was to express my opinion about the inappropriateness of this form of advertising, and that it implies patients/consumers should tell their doctors to prescribe the drug for them. Many of the drugs advertised are prescribed for diseases that are quite rare, and as a result have a limited number of patients for whom they are indicated. 

It seems that pharmaceutical ads are aired quite often. In fact, they are on TV more often than I realized. My television watching is limited mostly to the evening hours. My chances of viewing a pharmaceutical ad are limited to about 4-6 hours each day. When I realized how pervasive drug ads were I decided to keep a record of what drugs were being advertised and for what reason they would be prescribed. Interestingly, much of our evening viewing time was spent watching programs from streaming services which have no advertisements. So the hours sampled for drug ads were more like 1-3 per day. 

I kept track of ads I saw during programs on Monday and Tuesday evenings between 5:00 pm and midnight. That would have totaled 14 hours of viewing, but 8 of those were free of ads. During that 6 hours, over two days I saw fourteen (14) ads for pharmaceuticals, and I may have missed one or two more. During some commercial breaks, two drugs were advertised back-to-back. That seems like a lot of ads for one product category.  Few of them were for common, every day ailments suffered by a huge number of Americans.

A list of diseases and the drugs advertised to treat them follows next.

PSORIASIS and PSORIATIC ARTHRITIS: SKYRIZI,  TREMFYA,  OTEZLA

MIGRAINE HEADACHES: QUILIPTA

HUMAN PAPILLOMA VIRUS (HPV): GARDASIL

MYASTHENIA GRAVIS: VYVGART

MACULAR DEGENERATION: VABYSMO

AUTOIMMUNE DISEASES (RHEUMATOID ARTHRITIS,  PSORIATIC ARTHRITIS, CROHNS

     DISEASE, ULCERATIVE COLITIS, ECZEMA):  RINVOQ

FACIAL WRINKLES, MIGRAINE HEADACHES:  BOTULINUM TOXIN (BOTOX)

TARDIVE DYSKINESIA: INGREZZA

RESPIRATORY SYNCYTIAL VIRUS (RSV):  RSV VACCINE

HIV: UNNAMED DRUGS

HEPATITIS B: UNNAMED DRUGS

PAIN, FEVER: TYLENOL

Of these disorders, macular degeneration, migraine headaches, pain/fever, autoimmune diseases and cosmetic problems are the most common. Psoriasis is common but despite Phil Mickelson’s claim, psoriatic arthritis is not. Ads for products used to treat these have a big market. Myasthenia gravis and Tardive dyskinesia are not common disorders. TD is an adverse effect of taking certain major tranquilizers for prolonged periods of time. HIV, Hepatitis B, and Human Papilloma Virus (HPV) are lifestyle-related diseases that occur more in certain groups of people. I never saw a patient with HIV and very few patients with Hepatitis B or HPV. If I had, I would have referred them to specialists for management 

Most of the advertised drugs are monoclonal antibodies, a new biotechnology that targets the specific antigen that causes the disease. Monoclonal antibodies are man-made. They are an “artificial” protein  that mimics the action of naturally-produced antibodies, and fight against the specific antigens. Pharmaceutical companies spend millions on research and development of these drugs so when the drugs receive FDA approval and come to market, to recoup some of the development expense, they are priced very high. DCTA helps public awareness and increases demand for the drugs. Psoriasis, migraine headaches, and macular degeneration are all common problems so I understand companies advertising for them. Tardive dyskinesia and myasthenia gravis are not common diseases so companies know they must stir patient interest somehow. Advertising is that ploy. 

Pharmaceutical advertising seems to pay off for drug companies because I see more TV ads for pharmaceuticals than for gasoline. The impact of DCTA is significant and was clearly demonstrated in a 2020 study about Super Bowl advertisements. This study reported on the impact of DCTA on the number of prescriptions written for two topical anti-fungal drugs during  30-day periods for two years after they were advertised during Super Bowls XLIX (49) and L (50). Efinaconazole and tavaborate we’re compared. Prescriptions for efinaconazole increased 91% and tavaborole increased 275% after SB XLIX, and increased “significantly,” and “only slightly,” after Super Bowl L. Without DCTA, it is estimated efinaconazole would have increased only 40% (not 91%) and tavaborole by 90% (not 275%). So, DCTA has a significant effect on drug utilization.

Cigarette advertising has been replaced by drug ads. I have mixed feelings about that exchange. It’s good because smoking is no longer glamorized by flashy ads that imply your sexier, tougher, or cooler because you smoke. It’s bad because of the reasons cited in my direct-to-consumer advertisement blog. My biggest beef with these ads is they encourage patients to ask their doctor to prescribe a drug that may not be right for them. Your doctor should be the final judge of such a decision. 

As you watch television over the next few weeks pay attention to how frequently prescription drugs are advertised. Ask yourself, “Have I ever heard of the disease for which it’s prescribed?” There’s a good chance you haven’t! These ads are so common that while writing this article I saw two other ads for Rybelsus and Paxlovid, prescribed for diabetes and COVID-19. Today, pharmaceutical ads are a poorly-accepted fact of life. They air all the time so I need to get used to them.

References: Gilkison WM. “Direct-to-consumer drug advertising.” DrGOpines.com 2023 June 12.

Gray MP, Rodriguez ASJ, Chen N, Good C, Hernandez I. Impact of direct-to-consumer drug advertising during the Super Bowl on drug utilization. Res Social Adm Pharm 2020 Aug;16(8):1136-1139.