Advertising Drugs to Consumers

A full-page advertisement in The New York Times for the oral anticoagulant apixaban (Eliquis) prompted us to prepare an article for The Medical Letter on Rethinking Warfarin, which is what the advertisement urged its readers to do. Apixaban is the latest of 3 new oral anticoagulants that are competing with warfarin for a huge market. But the evidence that needs to be considered before deciding on one oral anticoagulant or another for a given patient is very complicated. Should the patient be making that decision? Or trying to force it on his or her doctor? Why am I still taking bad old warfarin when I could be taking new and better apixaban?

I can understand the reason for advertisements in newspapers, on TV and on the Internet for Cialis to treat erectile dysfunction. Men who might not seek out medical help for sexual dysfunction are encouraged to do so. But advertising an oral anticoagulant for atrial fibrillation or an inhaled corticosteroid/long-acting beta agonist combination for COPD (Advair Diskus) seems out of line.

Of course these medications are advertised to the public because pharmaceutical manufacturers have found that, somehow or other, these ads increase sales. If they didn’t, one of the most successful industries in Western economic history would not be wasting its money on them. There was a time when the FDA did not permit pharmaceutical advertising to the general public, but that has passed, one small part of the  price we pay for the greater good of the First Amendment. So all we can do is make our readers aware of the advertising pressure and examine the wisdom of its message. Rethinking Warfarin. Watch for it in an upcoming issue of The Medical Letter.

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  1. Once again – it is all about the money. So sad on the part of Big Pharma (as well as on the part of Big Medicine). I would not grant slack as you do for TV advertisements for Cialis or other erectile dysfunction drugs. That is also all about the money. These days – TV adds aren’t needed to inform the public that there are medications available for treating “ED” – as that is by and large general knowledge. Those ads – as well as all other TV ads re use of medicines (in my opinion) – are all flagrant “all about the money” issues that I think have all crossed the line …

  2. When direct to consumer advertising first came on the scene, I was interviewed by a national publication. I was in favor of it on the grounds that anything that promoted discussion between a patient and a physician is a good thing. This enraged many of my colleagues and I heard from, I believe, all of them. I was probably wrong in that the data are clear that DTC advertising increases use of that drug. Even more interesting has been the creation of new diseases that people didn’t even know they had. The profusion of the use of serious agents such as duloxetine and apiprazole are clearly the response of a harried physician to the sly question, “ask your doctor if ….. is right for you.” Remember, “ED” did not exist as a condition any more than “Low T” until the advent of targeted advertisement. Now even EPIC recognizes ED.

  3. Personally, I’m thankful for all the ads for Lyrica that have resulted in the recognition of Fibromyalgia as a LEGITIMATE condition. Had that been the case in 2005, I might have been believed and not told by the psychatrist at a regional center he “didn’t believe fibromyalgia was a real condition, therefore you don’t REALLY need those pain meds and MUST BE an ‘addict’.” It’s tough to fight the “Have you stopped beating your spouse?” game when you’ve never played it. By the end of the mandatory evaluations, some of those commercials had started and I started quoting them. Little good came from them them but I tried. “The jury” is still out–as am I. But I hope to be back with a happy voice with which to speak.

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