Pharmaceutical Advertisement: Therapeutic or Toxic?

Editor’s Note: This is a series on the effect of pharmaceutical advertisements. See Part I and Part II to the series here.

Part III: Conclusion

With the AMA (American Medical Association) recently demanding that FDA ban all DTCPA (Direct to consumer pharmaceutical advertisement), it is critical to understand whether banning DTCPA is the solution. AMA represents the viewpoint of US based physicians who potentially considers DTCPA as toxic. But is it toxic for patients as well?

As promised in my last feature, I interviewed patients and healthcare practitioners in the United States as well as in other developed nations where DTCPA is banned. The United States and New Zealand are currently only two nations that allow DTCPA.

I was amazed and slightly puzzled at the reaction of patients and caregivers. Around 75% of patients and caregivers found pharmaceutical advertisements helpful and felt they made them more aware of their condition and therapies.

One patient battling lifelong depression confided in me claiming that a recent advertisement about a woman suffering from bi-polar depression that showed how difficult it is to cope with normal life under such a condition, made her feel more confident about her own condition. In her words:

There are people like me, you know! Now they come on TV as well. I can relate to that commercial so much, it’s like my story! And now, when I go out and people ask me why do I have depression, I refer to that commercial. It feels as if someone is listening to me. Someone cares for people like us.

Interestingly, when I asked a leading psychiatrist about his views on a similar commercial, he firmly rejected the idea. He said that commercials targeting mental illness, dermatology, and commonly, easily misdiagnosed diseases (such as mental illness, which don’t have biochemical or radiological confirmatory tests) are particularly challenging. The physician asserted that some of his patients, who do not manifest bi-polar symptoms, are asking him to prescribe drugs like mood stabilizers or anti-depressants. He also felt that with these commercials, a patient becomes a physician and starts diagnosing his own symptoms and this is particularly dangerous.

As a healthcare practitioner, I have encountered several episodes where patients end up consuming over the counter drugs for conditions that did not require those over the counter drug therapy.

Many times the manifestation of a disease can be easily confused; for example, how many times do we think before popping that drug for a common nasty headache, which could be a manifestation of a tumor, or worse retinal bleeding? I was and will always be concerned about drugs for weight loss and controlling hypertension and diabetes. These conditions often are co-morbidities of underlying disease and should be investigated and treated only under medical supervision.

I am not averse to traditional medicines; however, I have come across a medical emergency where a patient had been consuming over-the-counter drugs to control his diabetes without medical supervision: it lead him to diabetic ketoacidosis or diabetic coma. Any commercial, which promotes cures for such conditions, will always ring alarm bells in my mind!

However, the blame does not lie completely with the consumers or the drug manufacturers. Potential lack and delay in availability of resources and the high cost of navigating a complex health care system are root causes of such mis-diagnosis and self-medication-related adverse events.

In the Photo: Fighting the stigma associated with bi-polar depression. Photo Credit: Latuda Website. The author or the team have no conflict of interest with the drug manufacturer of Latuda.

I interviewed few patients and healthcare practitioners in other countries where they do not have access to DTCPA. Patients in general were wary of such commercials and they considered healthcare practitioners as the people ultimately responsible for treatment of their condition and thereby failed to understand how their lives would change with commercials of the drugs they might or might not take. They also felt that their drug prescribers knew best about the treatment to any disease as they were qualified and had spent years studying medicine. They also felt that it is best that such commercials be shown to prescribers rather than to the patients.

Healthcare practitioners on the other hand, were open to such commercials but only for a restricted number of diseases such as asthma and chronic obstructive pulmonary disease. Controlling such diseases requires good understanding of the use of medical devices such as inhalers; this is where physicians felt will be the real value of such commercials. Physicians felt such commercials could help the patients to understand the process better and help them remember the correct utilization technique over time.

To sum up, DTCPA has both positive and negative impact on the lives of consumers, caregivers and healthcare practitioners. It is not perfect but is banning commercials the solution to the challenges?

There are several short-term solutions to these challenges such as:

Delay the promotion of new drugs, particularly in conditions which are considered rare, orphan and have no proven “cure”;
Obtain approval of DTCPA from FDA before launch;
Develop regulation of online advertisement;
Include cost of the treatment;
Include adverse effect of the drug.

These are starting points for having a more robust DTCPA.

However, as with any regulatory process, it will be time intensive and challenging. As a healthcare practitioner, I am particularly concerned about over the counter drugs. These drugs do not require any kind of prescription and can be consumed in quantities that are not regulated in any manner. It has been years, but one my first clinical case was overdosing and poisoning due to an overdose of Tylenol. It is still hard to believe that it was a suicide attempt that thankfully was averted, yet the patient’s liver function was impacted for life.

For a full mindmap behind this article with articles, videos, and documents see #pharma

How many times have we considered the long-term impact of that accessible, affordable drug which is available over-the-counter?

Naproxen is a favorite in this category; it is easily available on shelves of almost all pharmacies and does not require any prescription. This drug relieves back pain and muscle fatigue but taken over time, results in kidney disease. And if you suspect you may be suffering from some kidney troubles due to your continued use of this otc medication, you can check out specialists like Nephrology & Hypertension Medical Associates (for hemodialysis) to find out if you need to proceed with any treatments. Always bewildered by these cases, I once asked a nurse practitioner and she had some great insights for me:

“When you can buy something which can reduce the pain, even for short span of time, but costs less, doesn’t require waiting for physician, or waiting for insurance to kick-in…What will you choose? Either you can use that time to earn money to feed your family or wait for your doctor!”

As a policy fellow, as I am deep diving into the complex world of healthcare policies. I think that nurse’s words are wise and insightful. Unless we fix our policies to ensure easier access to medicines and healthcare practitioners, the toxic effects of DTCPA will continue to impact our lives negatively. DTCPA has many lacunae but it also has a few advantages to it.

To consider banning something that is a revenue generator and has big lobbying efforts behind it might not be the best solution. Regulating and moderating these commercials to ensure that they have a desired impact would probably be a better alternative.

Hopefully, over-the-counter drugs will also face over time some regulations that reduce their undue consumption. I hope never to see again another case of Naproxen or Tylenol overdose.

Recommended reading: “JOHNSON AND JOHNSON RAISES GUIDANCE, BUOYED BY PHARMA GROWTH“