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Direct Selling of Prescription Drugs—How Big Pharma Soft Pedals Side Effects

If you are older, you probably watch television—many of us do. And if you watch American TV, you’ve seen hundreds of ads for prescription medications, and you’ve listened to long lists of warnings about their side effects. It’s only during the past twenty years that drug companies have been given the green light to run such ads, and actually in only two countries, the US and New Zealand.

You might have wondered, after hearing the horrific effects of some of these prescription drugs—blurry vision, blood disorders, suicidal thoughts, nausea—how anyone can absorb that information about a drug, and still believe it might be good for them. And why would drug companies take such a big risk? It’s not by choice—they are required by law to do so, in accordance with FDA (Food and Drug Administration) legislation. And no worries, drug companies have figured out that such advertising is very lucrative— they spend billions of dollars doing it. In 1997, drug companies spent roughly $17.1 billion on marketing for prescription drugs. By 2016, that figure was $26.9 billion.

Pharmaceutical companies have also figured out how they can adhere to FDA rules, and still attract you, the consumer, in spite of the horrific side-effects they are required to list.

In my household, we’ve become quite adept at using the remote to silence the dialogue, switching back to the program once the ad is over. Lately, however, the ads have become more frequent, sometimes several times during a show. The increase is so pronounced, we can’t keep up, and end up hearing much more than is tolerable. We are not imagining this—advertising monitor Kantar Media, reports that there has been an increase of almost 65 percent since 2012. Jon Swallen, Kantar’s chief research officer, says:

“TV ad spending by pharmaceutical companies has more than doubled in the past four years, making it the second-fastest-growing category in television during that time.”

The audience, who we are, and how we respond

Obviously someone is paying attention, taking it all in and actually going to their doctor and making the suggestion that they be given the advertised drugs, which of course, leads to sales.

Over the years, the audience has become older, people like you and me, who watch dramas and news shows—it’s well known that younger people don’t watch much television. The ads are cleverly done, situations come in the guise of scenarios and stories, and the actors are usually younger than we are, and always attractive.

How the style of the ads has been honed

The FDA wanted consumers to know all of the facts, and drug companies quickly realized they had to respond by making side effects appear less threatening to consumers. Initially, companies tried listing the side effects very rapidly, but the FDA objected. Then they tried using scenarios that distracted the viewers from the side effects, and again the FDA objected.

But eventually, they arrived at a solution. This is how they do it:

They use a calm voice

When the list of side effects come on, the voice is soft, the side effects are listed in a tone that is entirely comforting and sincere. Actors have honed a calm, professional-sounding style. Joey Schaljo,, a voice-over actor, (in an article by Megan Thielking) says:

“We use the same approach medical professionals do, telling a patient calmly: ‘We’re going to perform this surgery and there’s a 60 percent chance you won’t live,”

They keep the voice actor off screen.

Advertisers have discovered that consumers buy into the information better when they can see them and relate to them, so they often state benefits of the drug in scenes using onscreen actors, and side effects using an off screen actor, in a dispassionate, matter of fact voice. Sometimes the side effects are listed in more complex sentences, making them a little harder to understand.

They mix it up

When the FDA made it mandatory to provide an equal balance between benefits and side effects, they no doubt assumed that more information about the risks would lead to greater caution among consumers. Instead, it was discovered that when all of the side effects were presented, usually in a mix of minor risks (dry mouth and headache) and major risks (stroke, heart-attack, thoughts of suicide), consumers reacted by assuming that the the side effects were less severe than when only the worst risks were listed. They actually preferred the drug more, and were willing to pay more for it.

Psychologists call this the  dilution effect. It’s a bias that affects judgement when both relevant and non-relevant information is provided together. In other words, the worst information is diluted or diffused in the mass of information presented.

Are consumers sufficiently protected?

In May, 2018, the Journal of General Internal Medicine included a study, on Direct-to-Consumer Advertisements. In their investigation of two of the drugs considered, Toujeo  and Otezla, the FDA found that ads for these drugs included distracting scenes and music, and sometimes a running text on the screen during the risk presentation—measures that they thought hampered the viewers’ ability to absorb the information. Although these infractions were addressed, guidelines are still not always followed. This may be due to the lack of enforcement of ‘direct to consumer’ advertising requirements

Are things likely to improve?

An article by David Lazarus, in the April 10, 2018 edition of the LA Times, is especially pessimistic, saying that many countries in the developed world, along with the World Health Organization, has concerns about consumers making decisions based on 60 second sound bites. He says:

“The main problem, they say, is that these are complicated medical issues, and you simply can’t communicate everything a patient needs to know for an informed decision in under a minute.”

As outlined in the study, skeletal information offered in this manner, can be misleading, but that may not stop advertisers from pushing for more freedom. Lazarus adds:

“Don’t expect a crackdown anytime soon. The U.S. Food and Drug Administration, amid a rollback of government regulations under President Trump, is considering even more leeway for drug companies to pitch prescription meds.”

Given that the pharmaceutical community is so powerful, that doesn’t bode well for doctors, hospitals and consumers.

27 thoughts on “Direct Selling of Prescription Drugs—How Big Pharma Soft Pedals Side Effects”

  1. “It was discovered that when all of the side effects were presented, usually in a mix of minor risks (dry mouth and headache) and major risks (stroke, heart-attack, thoughts of suicide), consumers reacted by assuming that the the side effects were less severe than when only the worst risks were listed.”

    This finding worries me for what it suggests about people’s (in)ability to process information in order to arrive at an intelligent conclusion. As you noted, these ads have virtually taken over TV. My husband and I laugh at the horrendous list of possible side effects, including “inability to breathe.” NOT good. Or the ones that start off “Don’t take XXX if you’re allergic to XXX (as it may kill you if you do).” Obviously, one cannot know that without taking the drug. QED: Don’t risk it. On the flipside, the findings about how people (don’t) process the required danger warnings may explain a lot about why we have TheRUMP.

    1. Still the Lucky Few

      After listening to the ever-increasing litany of side effects recently, I was driven to find out why people buy into them. I was a bit shocked at how easy it seems to be to fool consumers! Thanks for adding your unique touch to my piece (inability to breathe, etc.). Doctors, in the first line of defense, must be very tired of how these companies are manipulating their patients!

  2. This is frightening. I know I despise all the drug ads, but I didn’t realize the extent to which people were responding by minimizing the risks in their own minds. We are at the mercy of the TV.

    1. Still the Lucky Few

      Unfortunately, these ads turn up during the programs we find most appealing! Thanks, Rin!

  3. Sure, the drug companies are powerful. But the FDA is more powerful. It should ban advertising to consumers for all prescription drugs, on the basis that viewers can’t possibly judge the effects of the drugs and can’t get them directly anyway but can only buy them thru the auspices of insurance companies or Medicare. Might save us consumers a little money, too!

    1. Still the Lucky Few

      I agree that advertising to consumers should be a no-no. It’s so in all countries except for New Zealand and the US. I don’t entirely understand how other countries dispense drugs, but in Canada, we can only get them by prescription, through our doctor. Medical needs are too complex for us to self-prescribe, which is what happens if we make decisions based on advertising. Thanks, Tom.

  4. Considering the epidemic lack of critical thinking skills in our country, putting low-information drug decisions in the hands of consumers is concerning. Since my husband and I don’t watch much live TV (so we can fast-forward through the commercials), I have missed the up-tick in the ads… thank goodness. And, we wonder why the cost of prescription drugs is so high.

    1. Still the Lucky Few

      I’m not happy to admit we watched more TV this year than ever before, Janis. Bob had an ‘off’ year, with a cold that hung on and on, so I kept him company in front of the television, more than usual. He started to comment on the proliferation of ads for prescription drugs, and I started to keep count. Then I did a bit of research, and found that the increase was actually documented. Summer is almost here, the weather is better, and so is Bob, and we’ve already cut down on TV viewing!

    2. “epidemic lack of critical thinking skills”

      In the end we are all responsible for ourselves, unless we are very young, disabled, or age has taken our ability to make informed decisions from us. Technology and social media do not promote critical thinking skills, and sometimes I think these new social forces actually hinder it, by atrophy if nothing else. We are our own drug control board.

      1. Still the Lucky Few

        What a perfect response, Maggie! I loved the phrase too—it represents what appears to be happening to people as they make social media the base for their thinking. It’s a poor substitute for discussion and reading, and is currently dominating the way public opinion is formed. Thank you, Janis and Maggie!

  5. I’ve seen a few of these ads, and do notice all the side effects. My problem is more doctors who don’t worry about side effects at all. Andy and I do our own research.

    1. Still the Lucky Few

      If and when we get a prescription, the pharmacist usually includes a sheet or two of side effects. Our doctor doesn’t mention them unless they are extreme, which is understandable, I think. But good on you for researching—we should all be doing that!

  6. We use the mute button when we can’t fast forward. The rapid increase in the number of ads in mind numbing. Our particular ‘favorite’ warning is that ‘fatal events’ have been reported. I continue to notice how ‘fake news’ where we are asked to both believe total nonsense (the caravans are coming; the wind energy causes cancer) and at the same time gloss over the obvious lies of what is really happening. So like what the advertisements are trying to do (gloss over the real danger) we are all being systematically programmed to bypass common sense. Soul numbing.

    1. Still the Lucky Few

      ‘Programmed to bypass common sense’—a very catchy phrase! We all need to be aware, and keep our wits about us. It’s a very challenging time, to be sure!

  7. Hi, Diane – I don’t watch television, but we do live in an open-concept home….so I have heard many of the commercials that you are talking about. Because I usually only listen to them (not actually watch them) I thought for sure I must be missing something. Seriously, who would want these drugs with such horrible side effects??! Thank you for your clear, well-researched and logical explanation.

    1. Still the Lucky Few

      I like your method of ‘not watching television’, just hearing it in passing, as you are no doubt going about doing other things. My husband, who isn’t nearly as busy or preoccupied as I am, watches a lot of sports and news programs. Unless it is a program I’m attracted to, I won’t join him and watch, but as I explained in my response to Janis, this was an unusual winter for us. Summer is almost here, and I’m sure to be in the garden or out walking, instead of watching television!

  8. a wonderful post to remind all of us to PAY ATTENTION! or better yet … change our lifestyles!
    how could you take something that even remotely might cause one of the side effects they admit?
    our entire drug (prescription especially!) culture is pitiful. I rely and trust my pharmacist more than the doctor. I also hit the MUTE button on the remote. there are very often at least four or five in a row. good grief. it’s tiresome and irritating in the extreme. and I don’t even watch that much TV.
    it has almost made me give up on the two shows that I DO watch!
    something I’ve noticed… they tend to move in slow motion. there’s always or usually a child or a dog in them. it’s all just very disgusting really.

    1. Still the Lucky Few

      The ads play on our emotions—children and dogs have direct access to our hearts, so of course, using them shamelessly is what they do. The pharmaceutical industry will stop at practically nothing to make money, which is why they exist. They are not in it help people.

    1. Still the Lucky Few

      We used to have a channel without ads. I don’t know when the CBC started using commercials, but now they appear as frequently as every other channel, it seems. Having television without advertising is expensive, however, and the Canadian people balked at raised taxes in order to support their media, no doubt. I do remember a dust-up about this a few years ago. Thanks, Bear, good point.

      1. The nasty Liberal Govt, that we now have is anxious to sell off our ABC, and the buyer in the wings just dying to get hold of it is rupert murdock, can you imagine what would then happen to OUR ABC.? The govt will do it at their peril. The Australian people have never baulked at the cost of running OUR ABC it used to cost 8cents a day for every Australian, I think it’s probably treble that now. But it’s worth every penny/cent

        1. Still the Lucky Few

          I agree, but I’m afraid we were asleep at the switch when the CBC opted to allow advertising, so now it’s too late. But thanks, I can always count on a good rant from you, Bear!

  9. I have had my share of problems with side effects but, luckily have escaped major harm so far. My GP who is also my personal friend after all these years now knows my problems and prescribes sensibly. Perhaps I am just lucky.

    1. Still the Lucky Few

      Some people create their own good luck, Rummuser—I’d say you are one of them! So glad you have a good GP!

  10. Luckily we don’t get ‘those’ ads but there are some similar ones ending in ‘if you suffer from these symptoms see your GP (hopefully they will prescribe this medication which will then heal you! Unsaid)

    What does annoy/irritate me are all the insurance ads during the afternoons. Life, work, death, they come at regular intervals. They must figure their target audience has just given birth, is off work due to accident or is about ty ark it. Possibly true but annoying just the same.

    1. Still the Lucky Few

      Hahahaha—so funny, Cathy! I’ve noticed that too. Corporate researchers are constantly hard at work, trying to find the right ‘niche’ audience to target! Still, it must pay off, or they wouldn’t be making such a big effort!

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