Seeing Through Big Pharma’s Slick Marketing Tactics

by Kim Sarros

The marketing of prescription drugs is prevalent on television and in print with advertisements featuring the familiar face of a celebrity spokesperson or actors depicting the vibrant, happy results of using the latest wonder drug.  Direct to consumer pharmaceutical marketing, currently permitted only in the United States and New Zealand, is a lucrative proposition for makers of prescription drugs, with an estimated $1.6 billion in advertising dollars spent by the pharmaceutical industry in the first half of 2007 alone.  The return on investment for these efforts is staggering, with a Kaiser Foundation study revealing that for every dollar spent on pharmaceutical ads, drug makers received a $4.20 increase in sales revenue (Rosch, 2008).   In one example, sleeping pill prescriptions increased 60% from 2004 to 2005 as a result of $345 million in advertising spent by two drug makers (Graydon, 2008).

Celebrities are often not aware of the dangers of the drugs they endorse. In 2004, Dorothy Hamill received criticism after Vioxx was withdrawn from the market but claimed she was never warned of the drug’s risks.

Direct to consumer marketing of prescription drugs is a practice bordering on unethical behavior by pharmaceutical companies who have placed a higher priority on profit than on the overall well being of the patient.  Pharmaceutical companies aggressively promote their newest drugs, and consumer perception is that these newer drugs are better than older, generic, or less expensive options.  One issue is that long-term negative side effects of newer medications are not yet known (Rosch, 2008), unwittingly putting many users of these prescriptions at risk of injury or death.  Even though pharmaceutical companies are required to the list side effects of their medications in advertising, these are usually downplayed while the benefits of the drug are highlighted or exaggerated.

The propensity of some pharmaceutical manufacturers to contribute to “the medicalization of normal life” (Graydon, 2008, p. 111) by developing prescription solutions to issues such as PMS and shyness is another concern.  In her book Our Daily Meds, Melody Petersen highlights this practice with the case of the drug Detrol, originally developed for incontinence.  This condition represented a fairly small market for the manufacturer so the company extended their reach to a larger market of people who were bothered by frequent urination, an issue formerly managed by means other than medication.  By creating a new condition requiring medication, the manufacturer, Pharmacia was able to broaden their audience for Detrol and boost their profits at the same time (Petersen, 2009).

Pharmaceutical ads generate consumer demand for prescription medications through marketing the illusion that there is a solution in pill format for whatever ails us.  Some of the more insidious ads tout the name of the drug yet fail to mention the ailment it is designed to treat, instead ending their ad with a statement such as “Ask your doctor if ‘New Med’ is right for you.”  These ads drive consumers to visit their physicians seeking information about the latest prescription solution.  In one study, actors in the guise of patients visited doctors’ offices requesting a specific medication.  Those who asked for the medication by name were usually prescribed the drug, even though they didn’t show symptoms of the condition the drug was intended to treat (Graydon, 2008).

This type of marketing contributes to a medical culture where patients seek a fast, convenient fix in the form of prescription drug remedies.  Additionally, doctors faced with patient requests for prescriptions based on advertising usually don’t discuss alternative solutions (Graydon, 2008).  Dr. Len Saputo succinctly sums this idea up in his book A Return to Healing: “Patients and physicians alike have been taught to reflexively turn to pharmaceutical drugs to manage most health issues.” (Saputo, 2009, p. 119).

The pharmaceutical marketing approach encourages neglect of the best interest of the patient from a holistic perspective.  While there’s no doubt that many people must take medication to manage life-threatening or chronic illnesses, and that no one should stop their medications “cold turkey,” there are many who needlessly take prescription medications under the influence of slick pharmaceutical ad campaigns.  When doctors write prescriptions as a response to advertising-driven demand, they miss the big picture of health.  In response to patient requests for prescription medications, physicians often neglect to address underlying issues that have led to the condition.  Many times, once the root issue is uncovered, there are steps that can be taken before relying on prescription medications.  Sometimes a simple lifestyle change can lead to marked improvement of a health issue.

Reducing the influence of pharmaceutical advertising involves patient education, which starts with educating health care professionals about alternative means to treat illness – a challenging proposition considering the prescription drug industry is entrenched in many medical schools.  In addition, pharmaceutical companies often supply lucrative perks and product samples to physicians, and advertise in medical journals, essentially surrounding physicians with a pharmaceutical healing model.  In today’s managed care environment, many physicians are also time-challenged, and have highlighted lack of time as an impediment to health promotion in their practices (Calderón, Balagué, Cortada, & Sánchez, 2011).  The ability to discern issues that have led to the patient’s condition, and providing education on alternatives to pharmaceutical fixes takes more time than simply writing a prescription, yet allowing time for physicians to interact with their patients is an important component of promoting lifestyle change and healthy alternatives to pharmaceuticals.

In a perfect world, direct to consumer advertising of prescription drugs would be banned, as it is in most other countries.  Because pharma is an influential industry in America, I don’t foresee any change in the near future.  Alternately, I would propose to decrease the impact of direct to consumer pharmaceutical ads with a three-pronged approach:

1. Ads should either feature an up-front disclaimer for television advertising or disclose in bold print for print media, how much a celebrity or physician endorser is being paid by the pharmaceutical company to promote the drug in question, particularly since these individuals create a sense of trustworthiness on behalf of the drug being marketed.
2. Side effects should feature prominently in ads.  Warnings should be bold and visibly placed as a precursor to text in print ads.  In radio or television format, the ad should begin with an announcer following a script to the effect of “The following product may cause x, y, and z side effects, including death.”
3. Doctors should be allowed time to interact with patients and should receive training in methods to seek out underlying issues from a perspective that addresses mind, body, emotion and community, with a focus on alternatives to pharmaceuticals.  I realize this last point means a huge shift in the way we do medicine, including completely changing the way the insurance industry reimburses physicians, as well as retooling the content of physician education at the medical school level.  It will take time and a strong grass-roots effort to make this shift.

As health educators and champions of honesty in marketing, it falls to us to push for reforms in how the pharmaceutical industry markets their products.  We also must lead the drive to educate our clients on the dangers of prescribing unnecessary medications, while promoting healthy alternatives to prescription pharmaceuticals, including diet and lifestyle change as the first line of defense from disease.  Education is the most powerful tool at our disposal for creating awareness and impacting change on the pharmaceutical industry’s marketing tactics.

References Used
Calderón, C., Balagué, L., Cortada, J., & Sánchez, L.. (2011).  Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients. BMC Health Services Research, 11(1), 62.  Retrieved February 8, 2012, from ProQuest Health and Medical Complete. (Document ID: 2503388871).

Graydon, S. (2008). Pushing prescriptions: Direct to consumer drug advertising.  Alive: Canada’s Natural Health & Wellness Magazine, (304), 108-113.

Rosch, P. (2008), Stress from deceptive drug ads and corruption.  (2008). Health & Stress, (5), 2-13. Retrieved February 6, 2012, from ProQuest Health and Medical Complete.

Saputo, L.(2009).  A return to healing: Radical health care reform and the future of medicine.  San Rafael, CA: Origin Press.

Marketing Health

by Leah Burkhart

Marketing is a bit like a car. How it is used depends on the driver. Its basic purpose is to bridge the gap between people selling goods and those who could have need of it by giving people information about those goods. If there is no current need, it is up to marketers to create one. Although seemingly benign, this can have profound implications where medicine is concerned. As it stands now, the current drivers of marketing in the medical field are pharmaceutical companies who have an interest in creating a need for their products. The result is a system that is as efficient at “creating” disease as it is at creating treatments. I have no desire to eliminate capitalism altogether or marketing in particular. What I do want, at least when it comes to health care marketing, is a new driver.

It is important to point out that marketing is not the only factor that is contributing to the system we now have in place. It is one piece of a very large, complex and sophisticated puzzle. First, we live in a society that places tremendous value on novelty and technology.^[1] We (and I say “we” because I, too, am guilty of this) marvel at the shine of a new x-ray machine or computerized tool when we walk into a doctor’s office, dental office, or hospital. In fact, 40% of Americans believe that medical technology can always save their lives…if only they can have access to it.^[2] Where there is demand, someone will step in and supply. Pharmaceutical companies are basically doing just that.

Government policy also plays a role. When someone designs something new, they can apply for a patent for his/her idea. Doing so allows that individual a temporary monopoly on his/her product. In other words, the government promises to enforce a law that insists no one can make that product or sell it but the inventor for a given period of time. If someone tries, the inventor can sue that individual. The logic behind this is simple. Presumably, the inventor took personal and financial risk in designing and creating the good. They should be permitted to get a return on that investment. Having a policy like this creates an incentive to invent new things.

Unfortunately, although the philosophy behind patents is rationally sound, it does not necessarily translate well in the health care system. It puts pharmaceutical companies under tremendous pressure to perpetually design new drugs so that they can continue to have immense profits (their shareholders insist!). This can lead to new and important discoveries (antibiotics, antiviral treatments, etc), but they can also yield less-than-impressive results. Petersen writes about the discovery of a drug that could curb the urgency to urinate: Detrol. Originally, only a small corner of the market had any need of it. The executives of the company, however, decided to market it to millions of Americans who may have been annoyed with their frequent bathroom use. In other words they “created” a disease^[3].

Sometimes the patent incentive results in companies making trivial changes to a drug in order to call it “new” without actually enhancing its effectiveness at all. For example, AstraZeneca took a pill, changed its color, and marketed it as “new and improved.” It was not proven to be more effective. But the novelty of it warranted a patent and, therefore, an extended monopoly on the product^[4].

Why should we be concerned about this? We pay more for our health care than any other country in the world. In addition, the inflation of our health care costs are currently at 7 percent (twice that of general inflation).^[5] The primary cause of this increase? Medical technology (which includes drugs).^[6] We all want to think that we are paying a high price for a high quality of medicine, but as it turns out, our dollars are going to a system that is creating problems that it, then, claims to solve. From the business perspective, this is genius. From the consumer perspective? I will let you decide.

What if we found a way to market health, instead of marketing treatments for disease? Is that even possible? Surgeon General Regina M. Benjamin, MD, MBA  states that she wants to make health the new focus in our country (rather than the absence of disease). She discusses the importance of joy, community, well-being, exercise, and nutrition. This is not some hippy straight off the psychodelic rainbow bus. This is the Surgeon General of the United States, . Great! But how do we get that message in concrete terms to a mass of people who live in a country who are overworked, overstressed, nutritionally deficient, and unhappy?

My first instinct is to suggest that government mandate that full-time work be 30 hours instead of 40. This would encourage businesses to hire more people to do less work thereby lowering the stress load on Americans. Or, another idea could be that government grant tax cuts for businesses who can prove that they address how “happy” and “healthy” their employees subjectively feel (rather than simply insisting, for example, that their employees get their cholesterol down or lose weight). Examples of that could be granting tax cuts for businesses that promote stress relief practices, or periodically survey their employees based on their level of overall satisfaction. Surely happy employees are far more productive than unhappy ones.

Unfortunately, there are some serious problems with my suggestions. Americans value hard work and stoicism. They might not actually want to work less or attend stress relief classes. Working less might also result in less money, and when so many Americans are struggling to make ends meet, working fewer hours might actually cause more problems than it solves. Poverty, after all, has been proven to be more harmful to health than risk behaviors such as smoking, lack of activity, and body mass index^[7]. In addition, employers would likely be highly resistant to such a change, as increasing the amount of employees would also mean increasing the number of people that would need to be given benefits for their labor. How, then, do we shift the perspective of the American public so that they can embrace things like joy, community, and time?

Perhaps the answer could rest in the hands of social marketers and health educators. Social marketing is a discipline that uses the tools of marketing, but instead of selling tangible products, it sells ideas. Much as with business marketing, social marketing researches the demands of consumers. But instead of asking about goods, they find out what kind of health programs would be most useful, and what kinds of ideas and behaviors the audience is willing to change or discuss.^[8] To be sure that social marketing strategies were most conducive to health, Who would be willing to pay for this? Why not enlist insurance companies to do so? They have as great an interest in keeping the public healthy as pharmaceutical companies have an interest in creating a need for their drugs.

Our current system was born from a marriage of government policy and private marketing. Government provided the incentives for businesses, and businesses provided incentives for consumers. I am not suggesting that we dismiss all that. Instead, I suggest we try and use that same machine with a new driver. Instead of preoccupying ourselves solely with productivity and dis-ease, why don’t we try shifting the focus to marketing health and wellbeing?

^[1] Callahan (2008). From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns. Garrison, NY: The Hastings Center. p. 79-82.  Available at http://vizedhtmlcontent.next.ecollege.com/CurrentCourse/w5/Callahan_medical%20tech_Hastings.pdf.

^[2] Callahan, 2008.

^[3] Petersen, M. (2008) Our Daily Meds. New York: Sarah Crichton Books.

^[4] Petersen, 2008.

^[5] Callahan, 2008

^[6] Callahan, 2008

^[7] Kovner, A., Knickman, J. (2011). Health Care Delivery in the United States. New York: Springer Publishing

^[8] Weinreich, Kline. What is Social Marketing?  http://www.social-marketing.com/Whatis.html 2/8/12