Tuesday, January 16, 2024

Ask Your Doctor

Ask Your Doctor About TV Ads
Nicholas Johnson
The Gazette, January 16, 2024, p. A5

It’s outrageous that Big Pharma keeps filling our living rooms with TV commercials for pharmaceuticals. Profits for Pharma, profits for TV industry, bad for your health.

All of the United Nation’s 193 countries forbid this manipulation – except the U.S. and New Zealand.

Over 7 billion people agree with me.

Why? As Elizabeth Barrett Browning once put it, “Let me count the ways.”

Examples for starters: Healthcare costs. Generics suppression.

Pressures on doctors. Costs of advertising. Unnecessary prescriptions. Off-label use. Side effects confusion.

For detail on a couple more:

1. One of the most effective ways of increasing Big Pharma’s global sales of $1.48 trillion, while decreasing Americans’ health, is to pound away on our television screens the message that only pills will enable our tiptoeing along the tulips-lined path to health. What a bucket of toenail clippings that is!

The law requires recitation of side effects. But coming at you with the frequency of a crazed woodpecker attacking a tree, amidst the deliberate diversions of dozens of scampering squirrels on the screen? How many side effects can you remember, let alone understand -- except perhaps “can be fatal”? [Photo: screenshot of one frame of pharmaceutical TV commercial. ("Fair use" because: Not of financial benefit to blog; tiny portions of drug commercial and of blog post; not used for art, but for news reporting and commentary; product not identified.) "Can be fatal" mentioned as possible side effect in sound track, but not in scrolled text of side effects on screen.)

Google “What will reduce your chances of getting cancer, a heart attack, high blood pressure, diabetes, dementia or other serious diseases -- while increasing years of quality life?”

Notice how few answers involve pills? Notice the overlap in recommendations – regardless of the disease?

You and I hold the keys to our pill-free longevity, health and happiness. Foods like fruits and vegetables (rather than sweet grease and salty grease), movement and exercise (150 minutes a week rather than recliner hours), regular sound sleep (7-8 hours rather than all-nighters), vaccinations, weight control (track your BMI), social time (face-to-face, smart phones pocketed), stress reduction, no tobacco and little alcohol.

It's not the law, it’s your choice.

Only take what your doctor prescribes. Ignore Pharma’s pricey pills promotions. Save your money.

Create your own health.

2. Why does Big Pharma spend a billion a month advertising pills to people who can’t legally buy them?

Ever thought about that? We can’t buy this stuff without a doctor’s prescription.

It’s like manufacturers putting TV commercials for toys in children’s programs. Few children in that audience can afford them. But manufacturers profit off the free child labor that will pester parents.

Similarly, Big Pharma’s TV ads are the drug pushers’ effort to profit off free adult labor pestering doctors.

3. “It’s all about the money.”

There are many providers of products and services, capitalist competitors with prices regulated by “the market,” who well serve the public. But there are essentials, such as housing and health care, for which charging an unregulated, profit-maximizing price is unacceptable. Especially when Americans must pay for a drug 8 times the price charged in Turkey, as taxpayers pay half the total pharmaceutical research costs, and Big Pharma keeps all the profits.

In the spirit of “All the News That Fits We Print,” this is only a sample. Want more? Ask your doctor.

Nicholas Johnson was former co-director of the Iowa Institute for Health, Behavior and Environmental Policy. Contact mailbox@nicholasjohnson.org

193 countries; 191 forbid TV pharmaceutical commercials.

“Who are the current members of the United Nations?” Dag Hammarskjold Library, United Nations, Dec. 5, 2023, https://ask.un.org/faq/14345 (“There are currently 193 UN Member States. Each of the Member States of the United Nations has one seat in the General Assembly.”)

Ziad F. Gellad and Kenneth W. Lyles, “Direct-to-Consumer Advertising of Pharmaceuticals,” National Library of Medicine, National Institutes of Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967783/ [Am. J. Med., 2007 Jun.] (“Direct-to-consumer advertising emerged from relative obscurity in 1997 to become a potent force shaping the future of health care, and the United States and New Zealand are the only countries in the world at present to allow it.”)

7 billion in 191 countries (world minus U.S. and New Zealand).

“World Population 1950-2024,” macriotrends, https://www.macrotrends.net/countries/WLD/world/population (“The current population of World in 2024 is 8,118,835,999, a 0.91% increase from 2023.”)

“U.S. and World Population Clock,” U.S. Population, U.S. Census Bureau, https://www.census.gov/popclock/ (“The United States Population on Jan. 9, 2024 was: 335,921,625)

“New Zealand Population,” worldometers, https://www.worldometers.info/world-population/new-zealand-population/ (“New Zealand Population (LIVE) [Jan. 10, 2024], 5,250,254)

(US + NZ = 341,171,879)

(World – US & NZ = 7,777,664,120)

Elizabeth Barrett Browning “count the ways”).

Elizabeth Barrett Browning, “How Do I Love Thee?” (Sonnet 43), poets.org, https://poets.org/poem/how-do-i-love-thee-sonnet-43 (“How do I love thee? Let me count the ways. I love thee to the depth and breadth and height My soul can reach,. . ..”)

Examples for starters.

See, “Reasons to oppose TV pharmaceutical commercials,” below.

$1.48 trillion.

“Global pharmaceutical industry - statistics & facts,” statista, https://www.statista.com/topics/1764/global-pharmaceutical-industry/ (“The market has experienced significant growth during the past two decades, and pharma revenues worldwide totaled 1.48 trillion U.S. dollars in 2022.”)

FDA regulation of TV pharmaceutical commercials.

“Direct-to-Consumer Prescription Drug Advertisements: Presentation of the Major Statement in a Clear, Conspicuous, and Neutral Manner in Advertisements in Television and Radio Format,” U.S. Food and Drug Administration, Nov. 21, 2023, https://www.fda.gov/about-fda/economic-impact-analyses-fda-regulations/direct-consumer-prescription-drug-advertisements-presentation-major-statement-clear-conspicuous-and (“This final rule implements a statutory requirement that in human prescription drug advertisements presented directly to consumers in television or radio format (DTC TV/radio ads), and stating the name of the drug and its conditions of use, the major statement relating to side effects and contraindications must be presented in a clear, conspicuous, and neutral manner.”)

Alternatives to pills.

Meghan Rosen, “When it comes to physical activity, every bit counts; There’s no such thing as “the best exercise.” Rather lots of things — big and small — can help,” Science News, Jan. 2, 2024, https://www.sciencenews.org/article/physical-activity-exercise-health-benefits

Talk to your primary care physician – or browse the Mayo Clinic site (https://www.mayoclinic.org/). Mayo says “Regular exercise can help you control your weight, reduce your risk of heart disease and certain cancers, and strengthen your bones and muscles.” https://www.mayoclinic.org/healthy-lifestyle/fitness/basics/fitness-basics/hlv-20049447



“Can You Lengthen Your Life? Researchers Explore How To Stay Healthy Longer,” NIH News in Health, June 2016, https://newsinhealth.nih.gov/2016/06/can-you-lengthen-your-life [https://newsinhealth.nih.gov/]

https://www.mayoclinic.org/healthy-lifestyle/ (Healthy lifestyle topics Birth control - Healthy lifestyle topics Birth control Consumer health - Healthy lifestyle topics Consumer health Fitness - Healthy lifestyle topics Fitness Nutrition and healthy eating - Healthy lifestyle topics Nutrition and healthy eating Quit smoking - Healthy lifestyle topics Quit smoking Sexual health - Healthy lifestyle topics Sexual health Stress management - Healthy lifestyle topics Stress management Weight loss - Healthy lifestyle topics Weight loss)

“Prevent Heart Disease,” Centers for Disease Control and Prevention, https://www.cdc.gov/heartdisease/prevention.htm (fresh fruits and vegetables; healthy weight; physical activity (150 minutes/week))

Exercise and chronic disease: Get the facts

Mayo Clinic https://www.mayoclinic.org › in-depth › art-20046049 Exercise can improve the quality of life for people who've had cancer. It ... For people with type 2 diabetes, exercise can lower the risk of dying of heart ...

It's Never Too Late: Five Healthy Steps at Any Age

Johns Hopkins Medicine https://www.hopkinsmedicine.org › health › its-never-... Exercise lowers your risk of heart disease, type 2 diabetes, high blood pressure ... to reduce the risk for heart disease, diabetes, some cancers and dementia. ‎Be Active More Often · ‎Improve Your Diet · ‎Challenge Your Brain

Promoting Health for Older Adults

Centers for Disease Control and Prevention (.gov) https://www.cdc.gov › publications › factsheets › pro... Aging increases the risk of chronic diseases such as dementias, heart disease, type 2 diabetes, arthritis, and cancer. These are the nation's leading drivers of ...

Big Pharma’s advertising budget.

“Pharma advertising spending in the United States from October 2022 to January 2023,” statista, https://www.statista.com/statistics/1407234/pharma-ad-spend-us/ (Oct. 2022 and Nov. 2022 $1.2 billion each month; Dec. 2022 and Jan. 2023 $1.1 billion each month)

ICYMI: NEW STUDY FINDS BIG PHARMA SPENT MORE ON SALES AND MARKETING THAN R&D DURING PANDEMIC; AHIP Study Finds Top Drug Companies’ Sales and Marketing Budgets Swamp R&D Budgets,” Campaign for Sustainable Rx Pricing, https://www.csrxp.org/icymi-new-study-finds-big-pharma-spent-more-on-sales-and-marketing-than-rd-during-pandemic/ (“In case you missed it, America’s Health Insurance Plans (AHIP) released a new study Wednesday that found Big Pharma continued to spend more advertising and selling its products than investing in research and development (R&D) even amid unprecedented focus on the development of new treatments as a result of the COVID-19 pandemic.

The study found that ‘Of the 10 drug manufacturers examined, 7 of them spent more on selling and marketing expenses than they did on research and development.’”)

Reasons to oppose TV pharmaceutical commercials.

“A Perilous Prescription: The Dangers of Unregulated Drug Ads; Drug advertising policies need to be updated to protect public health,” Johns Hopkins Bloomberg School of Public Health,” March 2, 2023, https://publichealth.jhu.edu/2023/the-dangers-of-unregulated-drug-ads

Natasha Parekh and William H. Shrank, “Dangers and Opportunities of Direct-to-Consumer Advertising,” J Gen Intern Med. 2018 May; 33(5): 586–587; NIH, National Library of Medicine, National Center for Biotechnology Information, May 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910355/ (“The average television viewer in the United States (US) watches as many as nine drug advertisements per day and about 16 hours per year, far exceeding the time an average individual spends with his/her primary care physician.1 Since 2012 [2013-2017], spending on drug commercials has increased by 62%, and $5 billion were spent on drug commercials last year.2 Given their ubiquity, the article by Klara, et al. in this issue of JGIM offers one more piece of evidence to indicate that this medium is not operating as intended, and to force us to consider alternatives to the status quo.3 . . . the FDA has won substantial law suits and enforced penalties against pharmaceutical companies. For example, in 2012, Glaxo Smith Kline paid $3 billion and Abbott paid $1.6 billion in penalties for miscommunicating information in DTC advertising, while Eli Lilly paid $1.4 billion and Pfizer paid $2.3 billion in 2009.5 . . . DTC ads have been shown to misinform patients by over-emphasizing treatment benefits, under-emphasizing treatment risks, and promoting drugs over healthy lifestyle choices.1, 6 DTC advertising may also lead to overutilization and inappropriate prescribing.6 . . . Patients who requested drugs received them significantly more often than those who did not, suggesting patient requests have a dramatic effect on physician prescribing.7 Furthermore, critics argue that DTC advertising can impose strains on the patient-physician relationship and limit already limited appointment time with patients.1, 6 Perhaps the most significant critique of DTC advertising is its effects on rising drug costs due to over-prescribing of both inappropriate and brand name drugs (especially when cheaper generics are available). According to the Department of Health and Human Services, prescription drug spending in the US was about $457 billion in 2015.8 . . . The authors found that among 97 advertisements reviewed by authors, the quality of data presented was low—26% provided quantitative information for efficacy and benefit, 0% provided quantitative information on risks, and 13% promoted off-label use of medications (which is banned by the FDA). . . . How can we optimize the benefits of DTC advertising in empowering and engaging patients while minimizing the attendant risks of poor-quality DTC advertising? One option supported by the American Medical Association is banning DTC advertising.9 [9. American Medical Association. AMA Calls for Ban on DTC Ads of Prescription Drugs and Medical Devices. Published November 2015. Available at: https://www.ama-assn.org/content/ama-calls-ban-direct-consumer-advertising-prescription-drugs-and-medical-devices. Accessed January 1, 2018.] It is notable that, outside of the US, DTC advertising is banned in all other countries except New Zealand.”])

Examples of drugs, commercials (text and videos); Ineffective recitation of side effects.

Google: 2023 TV pharmaceuticals commercials

YouTube: 2023 TV pharmaceuticals commercials

Specific YouTube search: https://www.youtube.com/results?search_query=2023+TV+pharmaceuticals+commercials

Paxlovid Jardiance (4) Ozempic Otezla Chantix Pfizer vaccine Mounjaro “Pharmaceutical Ads – View Full Playlist” Dupixent “Find Pharma Ads – Browse Our Wide Range of Results”

TIME – Deceptive Drug Ads, https://www.youtube.com/watch?v=C7FGtYVQMFc

Amount Big Pharma spends on TV ads.

Julia Faria, “Pharma and healthcare industry advertising in the U.S. - statistics & facts,” statista, Dec. 18, 2023, https://www.statista.com/topics/8415/pharma-and-healthcare-industry-advertising-in-the-us/#topicOverview (“Prescription drug expenditure in the United States from 1960 to 2021,” $378 billion in 2021; “Pharma advertising spending in the United States from October 2022 to January 2023,” each month from Oct. to Dec. of 2022, and Jan. 2023, Pharma advertising was between $1.1 and $1.2 billion per month)

TV audience can’t legally buy product (without prescription).

“Prescription Medicines,” Healthy Living; Use Medicines Safely, U.S. Department of Health and Human Services, https://health.gov/myhealthfinder/healthy-living/safety/use-medicines-safely (“Prescription medicines are medicines you can get only with a prescription (order) from your doctor. You get these medicines from a pharmacy. These medicines are only safe to use if your name is on the prescription.”)

“Prescription Drugs Fast Facts,” U.S. Department of Justice, https://www.justice.gov/archive/ndic/pubs5/5140/5140p.pdf (“Yes, it is illegal to use prescription drugs without a valid prescription or to distribute them.”)

Advertising children’s toys to children.

“Money Sense for Your Children – The Pressures of Advertising,” Areas of Interest, Extension, University of Nevada, https://extension.unr.edu/areas-of-interest.aspx (“Children and Advertising According to the Federal Trade Commission, in 2004 children ages 2 to 11 saw 25,600 total TV ads and 2 1/4 hours of ad-supported TV a day.1 . . . Many of the things that children request are things they want because of high-pressure advertising on TV, the Internet, radio and billboards and in movies, newspapers and magazines. Children who haven’t learned to read yet can recite TV commercials. Exposed to the highly developed sales techniques used in most media, our children are constantly pressured to buy. Advertisers specifically tailor their work based on research. Companies start early creating brand-loyal customers. Groups of 3- to 5-year-olds were able to identify logos for fast food, retail stores and TV icons when shown “flash cards.”2 Celebrities and program icons encourage youth to identify happiness with possessions and endlessly urge the buying of expensive clothes and branded foods. . . . “But First This Important Message . . .” Are those words familiar to you? They should be. The website for the Children’s Advertising Review Unit of the Better Business Bureau includes this comment: “It is estimated that children in this nation watch an average of 3.5 hours of television every day, the equivalent on an annual basis of a 50-day marathon of TV viewing.” Forty percent of infants are regular TV and DVD viewers, and that number jumps to 90 percent for 2-year-olds.5”)

Where “the market” well serves the public.

“How the U.S. Economy Works,” U.S. Department of State, https://usa.usembassy.de/etexts/oecon/chap2.htm (“There are limits to free enterprise, however. Americans have always believed that some services are better performed by public rather than private enterprise. For instance, in the United States, government is primarily responsible for the administration of justice, education (although there are many private schools and training centers), the road system, social statistical reporting, and national defense. In addition, government often is asked to intervene in the economy to correct situations in which the price system does not work. It regulates "natural monopolies," for example, and it uses antitrust laws to control or break up other business combinations that become so powerful that they can surmount market forces.”)

Housing prices.

Mike Bebernes, “Rent control is making a comeback,” Yahoo News 360, Jan. 31, 2023, https://news.yahoo.com/rent-control-is-making-a-comeback-201559070.html (With rental prices still up significantly from where they stood before the pandemic, a growing number of cities across the country are dusting off an old solution to keep housing costs affordable: rent control. During November’s midterm elections, voters in Santa Monica, Calif., Portland, Maine, and Orlando all approved ballot measures that would place new limits on annual rent increases. Boston’s progressive mayor recently released a rent control proposal for the city. In early January, a group of 50 Democrats in Congress sent a letter urging the Biden administration to take action to address “historically high rental costs and housing instability” in the U.S., including “anti-rent gouging” measures. . . . But the new wave of rent control proponents . . . argue that housing has become such an unmanageable expense for millions of Americans that allowing prices to rise without any limitations is a recipe for widespread displacement, higher poverty and homelessness.”)

Prices for U.S. drugs in U.S. are 8 times prices in Turkey.

Katharina Bucholz, “U.S. Drug Prices Sky-High in International Comparison,” Statista, Aug. 9, 2022, https://www.statista.com/chart/27932/us-prescription-drug-prices-in-international-comparison/ (“Depending on the country of comparison, U.S. residents are paying twice as much, three times as much or even more for their prescription drugs. Research by Rand Corporation has found that U.S. prescription drug prices surpass those in 32 other countries by around 150 percent on average. U.S. patients are even paying triple the price for Rx drugs as Koreans, Portuguese and Australians and 3.5 times as much as Slovakians, Greeks and residents of some of the Baltic countries. Turkey saw the cheapest prescription drug prices in the comparison, with Americans paying almost eight times as much as residents there.”)

Taxpayers pay half of pharmaceutical research costs.

Ekaterina Galkina Cleary, Matthew J. Jackson, Edward W. Zhou, “Comparison of Research Spending on New Drug Approvals by the National Institutes of Health vs the Pharmaceutical Industry, 2010-2019,” [American Medical Association] JAMA Health Forum. 2023;4(4):e230511. doi:10.1001/jamahealthforum. 2023.0511; https://jamanetwork.com/journals/jama-health-forum/fullarticle/2804378

(“Conclusions and Relevance The results of this cross-sectional study found that NIH investment in drugs approved from 2010 to 2019 was not less than investment by the pharmaceutical industry, with comparable accounting for basic and applied research, failed clinical trials, and cost of capital or discount rates. The relative scale of NIH and industry investment may provide a cost basis for calibrating the balance of social and private returns from investments in pharmaceutical innovation. . . .

In this cross-sectional study, evidence suggests the public sector makes substantial contributions to the foundational knowledge on which drug approvals are based,1,2,4,6-8,41,42 but less to patents6,9 or development.2,3,37,43 Conversely, the industry is primarily responsible for product development and sponsored more than 99% of the product launches in this data set.6

The objective of this work was to compare NIH investments in recent drug approvals with reported investment by the industry. This required an accounting for NIH spending with costs for basic research on the targets for these drugs, applied research on the approved products, phased clinical trials of failed products, and the recommended discount rates for government spending.30,31 This accounting adheres closely to methods used to estimate industry investment,19,20 while also recognizing fundamental differences in the nature of public and private sector investment in prevailing economic theories.10

These analyses suggest that NIH project costs for basic or applied research associated with the products approved from 2010 to 2019 were significantly greater than reported industry spending. Costs for the NIH were also higher than industry costs when both included spending on failed clinical trials of candidate products. Including clinical failures, NIH investment (calculated with either a 3% or 7% discount rate) was not less than industry investment calculated with a 10.5% cost of capital. Investment from the NIH calculated with clinical failures and a 3% or 7% discount rate was also not less than industry investment calculated with clinical failures, additional costs of prehuman research, and 10.5% cost of capital. These results suggest that NIH investments in pharmaceutical innovation are comparable with those made by industry.”)

Dr. Ekaterina Galkina Cleary, Dr. Matthew Jackson and Dr. Edward Zhou, “New study shows NIH investment in new drug approvals is comparable to investment by pharmaceutical industry,” Newsroom, Bentley University, https://www.bentley.edu/news/new-study-shows-nih-investment-new-drug-approvals-comparable-investment-pharmaceutical

“All the news that fits we print.”

“Adolph Simon Ochs,” Britannica, https://www.britannica.com/biography/Adolph-Simon-Ochs#ref754367 (To set his paper apart from its more sensational competitors, Ochs adopted the slogan “All the News That’s Fit to Print” (first used October 25, 1896) and insisted on reportage that lived up to that promise.)

Judy Flander, “All The News That Fits We Print,” Personally Yours, Medium, Oct. 13, 2020, https://medium.com/personally-yours/all-the-news-that-fits-we-print-76c73e50439c

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