What Congress can do to save billions (and thousands of lives) fast: ban prescription drug advertising to consumers

By Charlene Smith
There is a quick way Congress can save billions of dollars and thousands of American lives: ban direct to consumer prescription drug advertising. In 1999, the Food and Drug Administration allowed the broadcast of direct-to-consumer prescription drug advertisements.
The United States became the only country in the world to do this aside from tiny New Zealand. In April, the White House, referring to an “epidemic” of prescription drug abuse told us that, “from 1997 to 2007, the milligram per person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams, an increase of 402 percent… In 2000, retail pharmacies dispensed 174 million prescriptions for opioids; by 2009, 257 million prescriptions were dispensed, an increase of 48 percent.”
Note the correlation in the commencement of broadcast ads about these drugs to the upswing in use and abuse. Today the United States with just four percent of the world’s population consumes almost half its prescription drugs. Our children pop two-thirds of the world’s supply of Ritalin. And 80 percent of the world’s opioid painkillers are consumed here, according to IMS Health.

A recent Centers for Disease Control report notes that by 2005 (when the epidemic was still in its early stages) opioid abuse was costing the U.S. more than $8.6 billion a year, and $9.5 billion in lost productivity. The death toll is around 37, 000 Americans a year and is second only to traffic accidents.

Prescription drug abuse is almost entirely an epidemic of the educated, employed white middle-classes – usually educated males aged 30 to 60.
Opioid painkillers are now so extensively abused that teenagers are more likely to experiment with the drugs in mom and dad’s medicine cabinet than to try marijuana. The National Survey on Drug Use and Health reported in 2010, “a marked decrease in the use of some illegal drugs like cocaine.” The quantity of cocaine seized in El Salvador and destined for the United States plummeted for the second consecutive year, from 4,074 kg in 2007 to 394 kg in 2009, according to the International Narcotics Control Board.
In the United States pharmaceutical companies earned $307.4 billion in 2010 ($270.3 billion in 2006) and by far the biggest seller was hydrocodone/acetaminophen or Vicodin, a Schedule Three painkiller and cough syrup. It netted $131.2 million in legal sales in 2010. The Drug Enforcement Administration says: “Hydrocodone [Vicodin] is the most frequently prescribed opiate in the United States with more than 139 million prescriptions for hydrocodone-containing products dispensed in 2010 and more than 36 million in the first quarter of 2011.”

In Oklahoma, Montana and Arkansas, the CDC says the number of deaths annually due to accidental overdose of prescription drugs has nearly tripled in the past decade, West Virginia has seen a 500 percent increase.

The Oklahoma Medical Examiner’s office says hydrocodone is most often involved, followed by the anti-anxiety drug alprazolam, and two other painkillers: oxycodone and morphine.
Accidental overdoses from Vicodin and other pain relievers kill more people than car accidents in 17 states, according to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. Public health and law enforcement officials said in a recent press conference that painkillers are now responsible for more deaths than crack in the 1980s and black tar heroin in the 1970s combined.
Jerry Avorn, an internist and professor of medicine at Harvard and the author of Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs, has observed: “Every other industrialized nation has figured out how to provide health care to all their citizens and how to get drug makers to negotiate the prices of their products, each of those countries (except New Zealand) also bans direct-to-consumer advertising for prescription drugs… All those other countries have it right, and we don’t. Doctors spend precious minutes of ever-shorter office visits explaining to patients why their cholesterol drug is every bit as good as the one they saw on television, or why feeling sad at the death of a loved one doesn’t require an antidepressant. Hawking medications to the public encourages rapid adoption of new products that may be no better — or even worse — than older, unadvertised generic drugs.”
The FDA threw a bonanza of wealth to drug companies and a burden for consumers. A May 2011, issue summary from the Congressional Budget Office noted that, “the average number of prescriptions written for newly approved brand-name drugs with DTC advertising was nine times greater than the average number of prescriptions written for newly approved brand-name drugs without DTC advertising.” The Kaiser Family Foundation reported in May 2010, that “manufacturer spending on advertising was over 1.5 times as much in 2009 ($10.9 billion) as in 1999 ($6.6 billion). “
The American Journal of Medicine has called for the federal government to “control the prices of prescription drugs as is done in nearly every other nation. Drug companies can charge whatever they wish in the U.S.

Citizens of other nations pay 20 percent to 40 percent less for prescription drugs compared with what Americans pay…

Some authorities have suggested that if we decrease the profits of drug companies they will stop developing new drugs. Given that drug companies spend more than twice as much for marketing and advertising as they do for research this is a very unlikely outcome.”
Former Merck Executive, Peter De Vilbiss agrees. He told Forbes magazine writer, Matthew Herper: “It is hard to make a case that a pharma company is R&D driven when a quick look at the income statement reveals that more money is spent on marketing and advertising than it is on R&D…. For one pharma to voluntarily ramp down it’s M&A spend significantly would be suicide…
“If there was a regulatory mandate for all pharma companies to cease direct-to-consumer advertising for prescription drugs and vaccines… bottom line profits could actually increase, providing more money for R&D and allowing companies to focus more time and energy on portfolio management of drug pipelines… the industry image and reputation may improve. It seems as if a lot of bad publicity arrived on the pharma scene as a result of all the DTC ads.”
Pharma, buoyed by its successes with broadcast has now turned its attention to online ads. Research firm eMarketer expects spending on online advertising to grow to $1.86 billion by 2015, up from $1.03 billion last year. For 2011, healthcare and pharma will boost web spending by 13 percent, to $1.17 billion. The danger with this was alluded to by The American Journal of Medicine: the U.S. has the highest prices in the world for prescription drugs which has led to a multi-million dollar cross border trade by citizens with Canada and Mexico. It has also fueled internet buying. As one such site observes: “Buying Celebrex at a Mexican pharmacy could be approximately 483% cheaper than the same drug bought at an American pharmacy.” The sites look authentic, most have lots of photographs of doctors and nurses, but few demand prescriptions and delivery is by a conventional courier within 24 hours. Legal and illicit sales become harder to discern and much harder for law enforcement officials to police.

In his lone dissent from the 1976 Supreme Court case that enabled drug companies to advertise, Justice William Rehnquist observed that “the societal interest against the promotion of drug use for every ill, real and imaginary, seems to me exceptionally strong.”

But it seems that while pharmaceutical companies remain the most powerful in the U.S. with the most prosperous lobbyists on Capitol Hill (they spent more than $250 million in 2009); fighting prescription drug advertising will be as hard as the war on tobacco advertising – and as necessary as addiction and deaths mount.