A Prescription for Healthy Medical Ads
For the average American, the most provocative breakthrough in medical care this decade might not come from researchers at the National Institutes of Health but from the copywriters on Madison Avenue.
While the health-care establishment may find prescription drug advertising aimed at consumers as appealing as a spinal tap, smart consumers should welcome it. Health-conscious people today crave knowledge and awareness about their options. Precisely because doctors still do a far better job prescribing medicine than information, consumer advertising must play a far larger role in stimulating dialogue between patients and physicians.
Currently, there’s only a smattering of prescription drug ads--and they do more to tease than enlighten. Regulators concede that changes are needed.
Obviously, advertising featuring a jut-jawed Lee Iacocca-type executive blustering in the pages of Time magazine that “Whenever I feel my ulcer acting up, I reach for my Tagamet,” or some come-hither blonde cooing on Lifetime cable that “I know that a man who can afford Rogaine is a man who can afford me,” clearly doesn’t qualify. Pharmaceutical ads shouldn’t promise cures; they should encourage questions.
The real issue isn’t whether advertising can hype prescription drugs the way it hypes Chevrolet and Miller Lite. It is where do you draw the line between promoting effective awareness and encouraging foolish consumption? As a matter of public policy, isn’t it a good idea to let people know what new medicines are available? Or is a tight-fisted regulatory paternalism necessary to eliminate even the shadow of possible consumer misunderstanding?
“The Food and Drug Administration is kind of grappling with its policy on direct-to-consumer advertising,” acknowledges FDA Commissioner David Kessler, who hopes that his agency will have a new plan to regulate drug advertising and promotion by the end of this year. “It’s very hard, in my opinion, to achieve fair balance. . . . For example, I’m not overly impressed with the information conveyed in any pharmaceutical drug advertisements.”
Quite properly, Kessler’s FDA has been cracking down on false or misleading advertising--punishing companies that contend that their products are “fresh” when they’re not. But eliminating misrepresentation on labels is not the same as promoting awareness of medicines. If it is clever, the FDA can craft a policy that could lead to better-informed consumers and a more competitive pharmaceutical marketplace.
“The public is entitled to and should have maximum information about health-care products--including prescription drugs,” asserts Burson-Marsteller Executive Vice President Wayne L. Pines, a former FDA associate commissioner who co-authored an article last year with Kessler on consumer drug advertising. “What we need is a debate on this very subject.”
That’s been conspicuously lacking. Ever since 1981, when the then-FDA commissioner made a speech to an industry group predicting exponential growth of direct-to-consumer pharmaceutical advertisements, the issue has been shaped less by public interest than by political loopholes.
The FDA has alternately banned such ads, regulated them with rules originally targeted for physicians or given pharmaceutical companies wide latitude--so long as the ad doesn’t mention the product’s name. For example, ads mentioning the brand name must include all the relevant medical information, such as possible side effects (a rule intended to keep them off television).
Some companies have even employed celebrities to endorse their medicines. Ciba-Geigy’s use of baseball great Mickey Mantle to promote its anti-inflammatory arthritis drug provoked tremendous controversy in the industry.
That’s one reason why American Medical Assn. member surveys consistently show strong opposition to direct-to-consumer advertising. “Since 1984, we’ve done two major surveys, both indicating that roughly 85% of physicians are opposed to direct advertising,” says Dr. Donald R. Bennett, director of the AMA’s division of drugs and toxicology.
Nevertheless, Bennett points out that the trend is toward better-informed patients who are willing to challenge their doctors. Ads designed to promote doctor-patient dialogue instead of sales would probably meet with less resistance, Bennett contends.
For example, an ad with the lead-in “What you need to know about hypertension if you are a black male between the ages of 28 and 50” should encourage the target group to seek out their doctor’s advice--not a prescription for a drug.
“There is the misconception that these ads will undermine the expertise of the learned practitioner,” says Elizabeth A. Moench, Ciba-Geigy’s executive director of public affairs. “In fact, ads that encourage awareness will not.”
“While I’m personally supportive of efforts to educate patients about drugs,” FDA’s Kessler says, “once one crosses the line into promotional aspects, I become skeptical about the benefits. . . . Once you’re into the realm of promotion, it’s very hard to control the messages.”
Just because it’s difficult doesn’t mean that it can’t be done. Instead of simply promulgating guidelines, the FDA should give serious thought to setting up a council of advertising, pharmaceutical, medical and regulatory representatives to create maybe five or six different “formats” for direct-to-consumer advertisements for print and video. These formats would be structured to encourage patient-physician dialogue and would include information relevant to general consumers.
Ads that fell outside these formats wouldn’t be FDA-approved. Ads that conformed would be reviewed by a standing council--but the FDA would have the right to veto the council’s recommendation.
For the first few years companies could be limited to maybe six consumer-ad submissions a year. If the council let through too many questionable ads, the FDA could slow the approval rate. If the ads fostered the appropriate balance of promotion and awareness, the approval rate could accelerate.
Ultimately, prescription drugs might play as big a role in the media marketplace as their over-the-counter brethren.
Is that bad? Or is it simply a necessary part of making people aware of the choices available to them?
Whatever the FDA decides, the issue of advertiser-supported medical information is going to become more important over the next decade, not less.
