As a physician, my blood pressure goes up every time I see the ad about the little purple pill, or the ad involving the guy throwing the football through the old tire (but which is not about throwing, or footballs, or tires), etc., etc., etc. I am convinced that such advertisements provide almost no education to patients. But they probably persuade quite a few to pressure their physicians for drugs that they may not really need, or that may not be the best choices for them. Promoting little purple pills shoves aside the complex balancing of benefits, harms, and costs that should underly choice of therapeutic agents. For how many patients with dyspepsia or GERD will that little purple pill really work better than a generic H2-blocker or proton pump inhibitor?
What has made the current news about the Cox-2 inhibitors so troubling is that the drugs were advertised heavily as generally useful for arthritis, and all sorts of aches and pains. Thus, many patients for whom the drugs provided no particular advantage were exposed to their risks of adverse effects. Will the lessons learned from this episode lead to decreased, and/or more informative and realistic direct-to-consumer drug advertising?
The NY Times today reported the extent of vested interests in keeping such direct-to-consumer advertising going. Merck's spending on advertising Vioxx was $78 million a year. Pfizer was planning to spend more than $87.6 million on advertising Celebrex this year until it canceled the campaign. $3.8 million is now spent yearly on all direct-to-consumer drug advertising. This is not a trivial business for advertising agencies. Furthermore, $110 million, about one-third of the advertising revenue of the big three network evening news programs, comes from direct-to-consumer drug advertising. It remains to be seen whether such vested interests will resist down-sizing direct to consumer advertising, or at least making it more realistic and less like "marketing for Cheerios."
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