COMMENTARY

We Should Ban DTC Advertising for Prescription Drugs

Disclosures

December 10, 2015

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Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

Oh my God; there it was, an unexpected bombshell.

Just like that, the American Medical Association (AMA) House of Delegates voted to ban direct-to-consumer (DTC) advertising of prescription products and some medical devices. The original resolution, brought by the Hospital Medical Staff section only to study DTC, suddenly snowballed into a resolution to ban it.

When politics reaches a tipping point, movement can be at lightning speed. The American public and its physicians are sick of egregious drug price gouging and ubiquitous, misleading DTC ads that drive drug use and costs way up. Our AMA actually did something that the great majority of American physicians can support. Hooray!

Will it have an effect? To evaluate that question, one needs perspective. Here is the brief history of drug advertising in the in the United States, from my 2001 book, Severed Trust.[1]

  • 1906: Pure Food and Drug Act said that medical products must be unadulterated.

  • 1924: Morris Fishbein became editor of JAMA and AMA asserted control over prescription drug promotion.

  • Before 1930: AMA told pharmaceutical companies that it would only accept ads in JAMA if "pharmas" stopped advertising nostrums and elixirs to the general public.

    • Pharmas complied because they learned that they could make more money selling drugs prescribed by physicians.

  • 1930: Fishbein led three AMA councils to award "Seals of Acceptance" to new drugs that passed AMA council tests for safety and efficacy. The JAMA advertising code controlled claims made by manufacturers about drug benefits.

  • 1938: An amendment to a congressional act first required that the US Food and Drug Administration (FDA) ensure drug safety if the drug was used as directed.

  • 1960s: FDA was given authority to control drug advertising.

  • From 1912 to 1949: Revenue to AMA from pharmaceutical advertising was sufficient to cover virtually all AMA expenses, and membership was without dues.

  • Mid 1980s: FDA relaxed its rules on DTC pharmaceutical advertising, and the industry responded quickly.

Aggressive marketing and advertising campaigns followed those rule changes, and pharma companies, Wall Street, investors, ad agencies, radio, television, newspapers, magazines, and Internet sites all made out like bandits, successfully hawking their now Big Pharma wares to consumers who drove prescribing by their physicians to new heights. The AMA expressed concern in the 1980s that DTC advertising would compromise the patient-physician relationship. But when AMA's own television programming needed the ad revenue to cover costs, AMA said that DTC was okay. And away we went. Money makes the world go round.

Since roughly the beginning of time (or recorded history), most developed countries have prevented the direct sale, marketing, and advertising of prescription drugs to patients. The United States was among those countries until the 1980s.

While Congress makes the laws for the President to sign, powerful organizations do their best to wield their influence to please constituents, be they members, as in professional and consumer organizations, or shareholders, as in for-profit companies.

Advertising of pharmaceutical products to the public unequivocally influences drug prescribing and use. Advertising of prescription drugs to physicians unequivocally influences drug prescribing and use.

Could the FDA itself prohibit DTC of prescription drugs? It could try, but Big Money from Big Pharma would raise holy hell with Congress and through the courts.

There is a major American right called freedom of speech and a relatively new factor called "freedom of commercial speech," also known as advertising. You know that the current US Supreme Court has ruled that corporations are people and that money may speak as people, so don't hold your breath.

This new AMA policy is only one step, but it is an important step, if the AMA executive hierarchy decides to put its lobbying clout behind its very popular new policy. This could be fun to watch.

That is my opinion. I am Dr George Lundberg, and this is At Large at Medscape.

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