Some new medications sell themselves thanks to compelling safety and effectiveness data. There is television advertising for those people, though.
A recent study found that just over 70% of prescription pharmaceuticals promoted on television were classified as having “poor therapeutic value,” which means they are not significantly better than currently available medications. The study, which was published in JAMA Open Network, supports long-standing doubts that medications that are heavily promoted have a high therapeutic value.
According to the authors, who include academics from Harvard, Yale, and Dartmouth, “one rationale would be that medications having high therapeutic benefit are likely to be recognized and prescribed without advertising, thus producers have greater incentive to market drugs of lesser value.”
Only two nations, including the US, permit direct-to-consumer (DTC) drug advertising, such as TV commercials. (New Zealand is the other.) A long history of protests against the uncommon practice has been made by doctors, medical organizations, and consumer groups. DTC advertising was described as “nothing less than an end-run around the doctor-patient relationship—an attempt to turn individuals into the agents of pharmaceutical companies as they urge physicians for prescriptions they may not need” by consumer advocacy group Public Citizen in 2006.
The American Medical Association demanded a complete prohibition on DTC advertisements for prescription medications and medical equipment in 2015. The advertisements, according to AMA members, “are driving demand for pricey treatments notwithstanding the clinical efficacy of less expensive options.”
However, DTC medication advertisements have persisted thanks to billions of dollars from the pharmaceutical sector.
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In order to conduct the new study, researchers under the direction of Aaron Kesselheim, director of Harvard’s Program On Regulation, Therapeutics, and Law (PORTAL), examined yearly rankings of the most popular pharmaceuticals advertised on US television between 2015 and 2021.
Additionally, they researched the therapeutic value rankings for such medications from unbiased health evaluation organizations in Germany, France, and Canada. Based on comparisons with other medications, the value ratings were determined by the therapeutic benefit, safety profile, and strength of the evidence for each drug. For the study, a medicine was considered to have a “high value” if it had a rating of “moderate” or above. The authors of the study selected the most favorable evaluation for pharmaceuticals with multiple ratings, which they note may have overestimated the percentage of higher-benefit medications.
Seventy-three of the top-selling medications have at least one value assessment. Between 2015 and 2021, pharmaceutical companies invested $22.3 billion in advertising for those 73 medications. Despite the high evaluations, 53 out of 73 medications (or nearly 73%) were labeled as low-benefit. The total cost of advertising for these low-benefit medications was $15.9 billion. By monetary amount, the top three low-benefit medications were Tofacitinib, Varenicline, and Dulaglutide (for type 2 diabetes) (rheumatoid arthritis).
The writers observe that there is little hope for reform. Kesselheim and his colleagues concluded that “policy changes would likely require industry cooperation or face constitutional challenge,” adding that “policy makers and regulators could consider restricting direct-to-consumer advertising to drugs with high therapeutic or public health value or requiring standardized disclosure of comparative effectiveness and safety data.”