Q&A: Common Trends, Examples of Misleading Drug Advertisements
Jenny Markell, BA, discussed the ongoing trends in prescription drug advertising and touched on her research into the impact it has on consumers.
Direct-to-consumer advertising of prescription drugs has become normalized in the US as top-selling, brand-name drugs flood the media with the ways they can benefit patients. However, as one of the only countries in the world that permits this advertising, research has shown dangerous trends that can mislead consumers and potentially harm patients.
“We always see those ads on TV and it's really only legal in the US and New Zealand; it's not legal in other countries,” said Jenny Markell, BA, PhD Candidate of Health and Public Policy at the Johns Hopkins Bloomberg School of Public Health. “In this study, we wanted to understand, in the US, what are the characteristics of these drugs that are being advertised on TV and in other places? We did this study that was descriptive, looking at the 150 top-selling branded drugs in the US in 2020.”
Markell discussed her research and how her findings may impact patients who constantly observe direct-to-consumer advertising for prescription medications. | image credit: LALAKA / stock.adobe.com
Markell and her colleagues collaborated on a study exploring the relationship between prescription drug characteristics and the amount of spending manufacturers allocated to advertise those drugs. She recently sat down with Drug Topics to discuss her team’s findings and how they may impact patients who constantly observe direct-to-consumer advertising for prescription medications.
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Drug Topics: Can you give us an example of how drug advertising may misinform potential consumers?
Jenny Markell: Just to start off, under FDA guidelines, pharmaceutical companies are supposed to provide a balanced view of drugs in advertising in terms of their risks and benefits. They're supposed to avoid any misleading information. It's illegal, for example, to overstate a drug’s benefits, misrepresent data from studies, or make claims that are not supported by adequate evidence. There are some examples actually on the FDA website of misleading information and misinformation that should not be included in advertisements. This could be something like having the benefits in a much larger font than the risks when they're supposed to be balanced. It could be something like showing an image of a child during an advertisement when the drug is actually only approved for adults. In that case, the consumer, by seeing the child, would assume that it's approved for that child, but in reality, it wouldn't be. Finally, another example would be showing an off-label use of a drug. An example of that is, if a drug is approved for something like allergy symptoms, if it's used off-label for asthma. Off-label use is not allowed to be advertised.
These are examples of things that currently shouldn’t be taking place with the current [regulations in] drug advertising, but they're not always caught. There are [processes] the FDA has where doctors are given a crash course and then a phone number they can call if they see a misleading ad, and there's a similar number for consumers. The process is that, if the FDA confirms this to be true, they can notify the drug manufacturer in a letter. But there's research that shows they've sent very few of those letters overall. There have been a few penalties enforced in lawsuits that the FDA has won over illegal information that's displayed in these advertisements that might be misleading. But again, I wouldn't say that that's the norm. That just gives you a sense, hopefully, of some of the misleading information that could be included in advertisements.
Drug Topics: One of the most common trends you’ve presented in your research is that a majority of advertising for top-selling prescription drugs in the US is for those with low-added benefits for patients. Can you elaborate on this? Why don’t advertisers target higher-cost drugs that at least have some benefit rather than little to none?
Jenny Markell: We did this study, which was led by my colleague Mike DiStefano, given the growth in direct-to-consumer advertising in the past couple decades, and because of the continued public attention to it. We always see those ads on TV and it's really only legal in the US and New Zealand; it's not legal in other countries. In this study, we wanted to understand, in the US, what are the characteristics of these drugs that are being advertised on TV and in other places. We did this study that was descriptive, looking at the 150 top-selling branded drugs in the US in 2020. We found that the average spending on this direct-to-consumer advertising, out of all promotional spending, was higher for drugs with lower added benefit. Essentially, what that means, the US doesn't have this added benefit system that some other countries have. So we mapped on the systems of France and Canada from their health technology agencies. They take into account several criteria to determine this ranking of added benefit, from low to major or low to high added benefit, that compare this new drug to an existing treatment that's already on the market.
In finding that association between more spending and lower added benefit, I think there's a few reasons why we might be seeing these drug companies advertise those drugs. First, there's some research that shows that direct-to-consumer advertising of drugs might increase patient requests for these drugs, and also the likelihood that they're going to be prescribed by doctors. If we're seeing more spending on these drugs, it could, in terms of their advertising, be a marketing strategy to increase prescriptions of those drugs and increase demand for those drugs. One other reason for that is it could be that this new drug has some similar competitors already on the market, but it might be more high cost, not have as good formulary placement. Because of that, it might be advertised more compared to lower-cost alternatives. I think that was something worrying we found in this study that was very interesting.
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