Some new drugs are marketed with impressive safety and efficacy data. For others, well, there are TV commercials.
A new study found that over 70% of prescription drugs advertised on television were rated as having “low therapeutic value.” The study, published in JAMA Open Network, is consistent with long-standing skepticism that highly touted drugs have high therapeutic value.
The authors, including researchers from Harvard, Yale, and Dartmouth College, concluded, “One explanation is that drugs of substantial therapeutic value are more likely to be recognized and prescribed without advertising, and therefore manufacturers are more likely to recognize value.” This may be due to the fact that there is greater incentive to advertise drugs with lower drug prices.
The United States is one of two countries that allows direct-to-consumer (DTC) pharmaceutical advertising, such as television commercials. (The other is New Zealand.) Doctors, medical associations and consumer advocates have long opposed the unconventional practice. In 2006, consumer advocacy group Public Citizen summarized D2C advertising as “nothing less than a dead end in the doctor-patient relationship and an attempt to turn patients into agents for pharmaceutical companies.”
In 2015, the American Medical Association called for a total ban on DTC advertising for prescription drugs and medical devices. AMA members said advertising “is driving demand for expensive treatments despite the clinical efficacy of cheaper alternatives.”
But advertising for DTC drugs continues, fueled by billions of dollars from the pharmaceutical industry.
No perks added
For the new study, researchers led by Aaron Kesselheim, who heads the Program on Regulation, Therapeutics, and Law (PORTAL) at Harvard University, found the number of drugs most hyped on television in the United States between 2015 and 2021. I checked the monthly list.
They also examined therapeutic value ratings of these drugs from independent health assessment agencies in Canada, France, and Germany. Based on profile, and strength of evidence. Drug ratings of ‘moderate’ or better were classified as ‘high value’ drugs for this study. For drugs with multiple ratings, the study authors used the most favorable rating, but the authors caution that this may overestimate the proportion of more effective drugs.
Of the top advertised drugs, 73 had at least one valuation. In total, pharmaceutical companies spent $22.3 billion on advertising for these 73 drugs between 2015 and 2021. Despite generous valuations, 53 of the 73 drugs (about 73%) were classified as low profit. Collectively, these low-margin drugs accounted for his $15.9 billion in advertising dollars. The top three low-profit drugs by amount were dulaglutide (type 2 diabetes), varenicline (smoking cessation), and tofacitinib (rheumatoid arthritis).
The prospects for change are bleak, the authors note. “Policy makers and regulators should either limit direct-to-consumer advertising to drugs of high therapeutic or public health value or require standardized disclosure of comparative efficacy and safety data. We can look into it,” Kesselheim and his colleagues concluded. Or face a constitutional challenge. “
