Author of Southern Stories



Have I Got A Pill for You...


A friend of mine, a not-so-young mother of several children, was trying to unwind in a nice warm bubble bath the other day when her four-year old daughter barged in to interrupt her reverie.  “I know what you’re doing, Mommy,” the little girl said.  “You want to be ready when the moment is right—like those people in the bathtubs on television.”  Apparently, even pre-adolescents find the imagery of Cialis commercials attractively memorable.

Let me make it perfectly clear that I am a big fan of television commercials.  I always have been.  In today’s world of reality TV, commercials represent one of the last bastions of drama, wonderful venues for talented actors and clever directors.  When some advertising time slots sell for tens of thousands of dollars per second, everything has to be prefect—especially when you only have 60 seconds or so to get your message across.  Every smile, every caress, every turn of phrase is ideally designed to convince the unwary viewer that his or her life will be less than full without the inclusion of this or that product or service.

But there are limits.  I really, truly, honestly do not want to hear in lurid detail the benefits of those sundry products whose primary actions and uses lie somewhere south of the belly button and north of the knees.  I tolerated Mr. Whipple, but the Charmin Bears’ focus on bits of toilet paper sticking to nether regions is over the line.  And the products that promote the vaguely disturbing concept of “colon health” or promise to help remove “those five to twenty-five pounds of waste that are stuck to the colon walls like spackle or paste” are off the Ick Factor’s Richter Scale.

My biggest peeve, however, is what the pharmaceutical industry refers to as “direct-to-consumer” (or DTC) advertising of prescription drugs.  I have almost developed a love-hate relationship with them, beautiful examples of the adman’s skill designed to promote costly and sometimes inappropriate therapies to a medically naïve public.  To understand how we got to where we are, it is helpful to understand the history of pharmaceutical advertising.  Up until the early part of the twentieth century, drugs—and advertising to promote them—were essentially unregulated.  And until the 1950s with the advent of television, there were only limited ways to reach large numbers of potential consumers in a cost-efficient manner.

While drug companies have always advertised in medical and trade journals, ads aimed at consumers—in this case patients and potential patients—were rare prior to 1997.  At that time, the U.S. Food and Drug Administration eased restrictions on DTC advertising, but with the understanding that they would be closely monitoring the content of the ads.  From the paltry $12 million spent on such ads in 1989, the sums exploded to $844 million by 1997, rising to more than $5 billion in 2007 before falling slightly in 2008.  Direct-to-consumer advertising by the pharmaceutical industry now ranks consistently in the top five categories of spending, providing a regular income source to broadcasters and the agencies who fabricate the ads.

An ad is an investment.  To be effective, the return as measured by sales profits must exceed the cost, otherwise, the money is wasted.  While the FDA nominally reviews all ad content for truth and balance, this does not deter the goal:  the creation of new demand for a product that the consumer cannot purchase directly.   A recent study[1] of DTC advertising in the Annals of Family Medicine pointed out some disturbing trends.  95% of the ads appealed to viewers emotions.  They “often framed medication use in terms of losing control (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%).”  Think about the poor fellow who isn’t “ready when the moment is right.”

But hey, there’s the other side to the ads, the beauty of imagery and drama.  Remember the first Levitra ads, the one that had the guy throwing the football through the swinging tire on a rope?  Or the current Viagra commercials that end with the happy male, his blood saturated with essence of little blue pill, pulling the curtains, shutting the door, or flipping off the lights? 

If you don’t believe me, try this simple experiment.  The next time you see an ad on TV for some prescription drug, hit the “Mute” button and watch the video only.  With the narration absent, focus on the imagery—the smiling faces, the happy situations, the glorious sunsets, and all those other things that make life worth living.  Next, when the same commercial appears a few minutes later (as it always will), close your eyes and listen to the voice-over only.  The imagery there is one of fear and danger, from the mundane to the major.

Take the drug Abilify, for example.  A member of the class of medicines known as “atypical antipsychotics,” its manufacturer advertises it as an add-on drug for depressed individuals who have not responded well to antidepressants.  The dark imagery of the first third of the commercial gives way to bright scenes and smiling people as the announcer reminds the viewer of an “increased risk of death or stroke,” “high fever, stiff muscles, and confusion,” the risk of “uncontrollable muscle movements as these may become permanent,” and “extreme high blood sugar” that could lead to “coma or death.”  He throws in a warning of “seizures” for good measure.  But, at the end of the video, one of the now-smiling patients states, “Adding Abilify has made a real difference for me.”  What?  Confusion, coma, or seizures?

Or Requip, a drug prescribed for Restless Legs Syndrome.  The video portrays a happy young woman relaxing on a comfortable chaise.  Earlier, she’d complained “night after night, strange sensations in my legs.”  Obviously cured by Requip, she works a crossword puzzle while the soothing voice of an announcer advises users to, “Tell your doctor if you experience new or increased gambling, sexual or other intense urges while using Requip.”  The ad just happens to neglect mentioning other easier and far cheaper options for treating this condition, and equally importantly fails to define “other intense urges.”  Maybe nude basketball at midnight?  Who knows?

The problem with advertising prescription drugs on television is simply this:  While the medicines and treatments touted may be good and effective, they may not be the right ones for the individual patient, and they may not be the safest or most cost-effective options.   New Zealand and the United States are the only developed countries that allow direct-to-consumer advertising.  Pharmaceutical companies hope to increase sales and market share by having patients put pressure on physicians to prescribe some drug whose supposed near-miracle qualities are liberally reinforced by a 60 second ad aired between reruns of “Happy Days.”  Advertisers have never failed to underestimate the gullibility of the American consumer.

As much as I’d like it, I don’t think there is much chance of pharmaceutical advertising going away anytime soon.  There are discussions floating around the current Congress to remove the tax incentives as a way of saving money for other health care costs, something that might curtail the scourge. 

There are other considerations, too, those of cultural degeneration.  Cruelly co-opted by Big Pharma, The Flying Nun and Forrest Gump’s mother now speaks earnestly about “this one body and this one life,” both no doubt improved by her monthly ingestion of Boniva.  As I write this on August 16, 2009, I am reminded that today is the 32nd anniversary of the death of Elvis Presley.  This is the time of year for the annual Elvis tributes, with the airwaves and video screens of this great country full of his music and movies.  It saddens me to know that the rollicking theme from the movie “Viva Las Vegas” has now become “Viva Viagra,” the melodic mantra of erectile dysfunction.  Elvis must be spinning in his grave.

About the Author:  William Rawlings is a author and physician from Sandersville, Georgia.  He urges readers to go to www.youtube.com and check out the DTC videos. 



[1]  Frosch, DL, et al.  Ann. Fam. Med. 2007:5:6-13