Direct-to-Consumer Drug Ads Booming Despite Criticisms

WEDNESDAY, Aug. 15 (HealthDay News) -- Drug company spending on direct-to-consumer advertising continues to skyrocket, even as criticisms against it have soared.

Calling for a moratorium, rather than just restrictions, on such advertising might be in order, say the authors of a study in the Aug. 16 issue of the New England Journal of Medicine.

"Direct-to-consumer advertising spending is increasing in terms of its share of total marketing budget, but it's still a smaller share relative to promotion aimed at influencing prescribers," said study author Julie M. Donohue, an assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health.

The U.S. Food and Drug Administration started allowing direct-to-consumer advertising of prescription drugs on television 10 years ago.

Since that time, spots of Dorothy Hamill and Sally Field peddling Vioxx and Boniva, respectively, cartoon characters illustrating the effects of the antidepressant Zoloft, and a wide range of similar promotions have become commonplace on American TV screens and in other media.

But so, too, has criticism of the practice. Skeptics say that direct-to-consumer advertising encourages overuse of medications and drives up drug spending.

The controversy reached critical proportions when the arthritis drug Vioxx, one of the most heavily promoted medications ever, was withdrawn from the market in 2004 because of serious cardiovascular risks.

"It's been 10 years since the FDA clarified its policy with respect to broadcast advertising and unleashed direct-to-consumer advertising on television, which was new," Donohue said. "We wanted to see, in the wake of the Vioxx withdrawal and an increased focus on the safety of drugs and a focus on drug costs in light of the implementation of the new Medicare drug benefit, what industry and the FDA were doing with respect to advertising."

For this analysis, Donohue and her colleagues looked at pharmaceutical company spending on direct-to-consumer advertising and promotion to physicians over the past decade.

Total pharmaceutical industry spending on promotion soared from $11.4 billion in 1996 to almost $30 billion in 2005. During that time, spending on direct-to-consumer advertising increased by 330 percent, yet this type of advertising only made up 14 percent of total promotional expenditures.

These mass-media advertising blitzes generally start before a drug's safety track record has been established in the marketplace, the researchers said.

"For the majority of heavily advertised drugs, direct-to-consumer advertising starts within about a year of FDA approval and typically well before the safety profile has been established," Donohue said.

The most heavily marketed drug in 2005 was that "little purple pill," Nexium, a proton pump inhibitor heartburn drug, on which AstraZeneca spent $224 million. Next came the sleeping pill Lunesta ($214 million), followed by the cholesterol-lowering statins Vytorin ($155 million) and Crestor ($144 million), then Advair, a corticosteroid ($137 million). Viagra was 17th on the list, with $80 million spent in 2005.

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