February 9, 2011 Better Drug Ads, Fewer Side Effects By IAN D. SPATZ Washington
from Mark Ganzers Blog. Published NYT's op/ed February 10.

ON Aug. 8, 1997, Michael Friedman, then a deputy commissioner of the United States Food and Drug Administration, announced a policy change that let loose the forces of direct-to-consumer pharmaceutical television advertising. In a move neither actively sought by nor much discussed within the industry’s trade association, Pharmaceutical Research and Manufacturers of America, the F.D.A. opened a vast and untested venue for drug companies’ marketing departments by freeing TV drug ads of the previously unworkable requirement that they painstakingly detail side effects.
Nearly 14 years later, with parents confronting uncomfortable questions from their young children about “reptile dysfunction” and nearly $5 billion a year spent on TV ads for treating everything from toenail fungus to cancer, critics, the medical community and even the drug companies themselves are wondering if there is any way to put this genie back in its lamp.
In announcing the change all those years ago, Dr. Friedman said that it could “help promote greater consumer awareness about prescription drugs.” But the evidence on the public benefits of broadcast direct-to-consumer drug advertising is mixed. Employers who pay the health insurance bills complain that the ads drive unnecessary use of medical care and steer patients to expensive brand names and away from generics. Doctors report feeling pressured to prescribe the most heavily advertised products. The drug industry and allies among patient organizations point out that, for many chronic conditions, the real issue is underuse of effective medicines and that generic drug use is at its highest levels ever.
Patients, however annoyed they may be with the ubiquity of the ads, also report valuing the information they receive. The ads appear to not only drive conversations between patients and doctors but also remind those who already have been prescribed medicines to take them.
But we’ve reached a point where the drug companies may be looking for a way to change the system. While big pharma’s belief in advertising’s benefits — both for their finances and for their customers’ health — remains strong, direct-to-consumer ads are expensive, and companies often buy them merely to blunt the impact of their competitors’ ads. In addition, many drug company chief executives recognize that the F.D.A.’s 1997 decision to allow the ads has, inadvertently, caused the public to view the industry as focused no longer on research but on sales — and made patients ask whether the companies are more concerned with profits than with safety.
At this point, however, the drug companies themselves are stuck with the ads. Despite the widespread belief that the pharmaceutical industry is a monolith, competitive pressures drive individual drug makers to advertise to make their products more sought after than substitute medicines to treat conditions like asthma, diabetes and, of course, erectile dysfunction.
A few years ago, Congress took a stab at regulating direct-to-consumer drug ads on TV, but some drug companies partnered with ad agencies and broadcast media owners and effectively blocked the effort. But even if Congress had tried harder, it is very possible that such regulations on advertising would have run afoul of the First Amendment in court.
A more effective way to limit the ads would be for Congress to pass legislation that would allow drug companies to cooperate with one another, and with physician and patient organizations, to develop joint ad campaigns that are specific to certain diseases and conditions but not to any particular drug. These ads would inform consumers about the disease; its treatment options, including pharmaceuticals; and how to gain further information not biased toward any particular brand.
A precedent for such agreements can be found in a 1920s law, the Capper-Volstead Act, which provides an explicit legal exception to the federal antitrust laws for agricultural producers, so that they can, among other things, jointly market their products. The law provides the government with broad powers to police these alliances to ensure that they do not provide a forum for companies to set prices.
With such cooperative agreements, drug companies could trim their individual marketing budgets. Advertising agencies and broadcasters would still retain some of the billions of dollars in drug ads that support programming, including news. And patients and caregivers would be spared the assault of promotional messages, often unintelligible warnings about side effects, and cloying images that make up much of current TV drug advertising.
Instead, we’d get unbiased information about the medical conditions we care about, and encouragement to seek out the medicines and vaccines that can help us maintain and improve our health.
Ian D. Spatz, a former vice president for global health policy at Merck, is a senior adviser to a law firm that has pharmaceutical companies as clients.