Advertising drugs on the air waves? Yes, but only in the United States and New Zealand.

I’ve never been to New Zealand but if I were to visit one thing would make me feel at home. I’d be exposed to television ads promoting prescription drugs.

Among the developed countries only the United States and New Zealand allow direct to consumer advertising (DTCA) of prescription drugs. Could the massive amount of money spent on this marketing effort be allocated to better causes?

In the US it is practically impossible to watch television for more than a few minutes before a commercial for one drug or another appears. The reason is obvious. The pharmaceutical companies have found that they sell more product if they reach out directly to consumers. The problem is that consumers are ill equipped to evaluate the merits of the medication being promoted. The power of suggestion, especially when bundled professionally by big marketing, is often irresistible.

The proponents of DTCA would argue that marketing directly to consumers is a valuable educational service for the public that results in higher levels of treatment of undiagnosed conditions. It also results in patients appearing in physicians’ offices determined to get a prescription for a condition they may or may not have. For some healthcare providers it is difficult to resist the insistent request for a prescription from a highly motivated patient who “just knows” they have the symptoms that appeared in the commercial. Regardless of the reason, there is a positive correlation between the number of prescriptions written for a particular drug and the amount of advertising of that drug. In short, DTCA works. But is it the right thing to do?

The pharmaceutical industry spends approximately 30 billion dollars annually promoting their products of which 5 billion is spent on DTCA. (See attached file, NEJMsa070502.pdf). The $30 billion number caught my attention. In 2008 Jacques Diouf, Director General of the Food and Agricultural Organization of the United Nations, stated that 30 billion dollars a year would “eradicate the scourge of hunger.” The Director General stated “Against that backdrop, how can we explain to people of good sense and good faith that it was not possible to find US $30 billion a year to enable 862 million hungry people to enjoy the most fundamental of human rights: the right to food and thus the right to life?” (1)

Given the choice of spending $30 billion on marketing drugs in the US or spending $30 billion to eradicate hunger worldwide which would you choose? I know that’s obviously a logical fallacy, but false dilemma or not, it frames an interesting comparison.

What is logical is to eliminate DTCA. There has been discussion of a government enforced moratorium on DTCA and some chief executives of pharmaceutical companies appear to be receptive to limiting DTCA. If DTCA were to be eliminated, there would be an immediate $5 billion savings for the pharmaceutical industry. I know those savings would be redistributed within the company or to shareholders but think of what could be accomplished if it were directed to world hunger. As a starter, the World Food Organization states that $3.2 billion would feed 66 million hungry school children (2). Think of what the $150 million spent just on consumer marketing of Cialis could accomplish.

I understand that big business will never take bold, decisive altruistic actions. It is not in their nature. Their charter is to maximize profits. At the same time I can’t help but wonder if our priorities as a society are askew when I see so much spent on marketing drugs that could have been used to do real good for far more people. Maybe I’m dreaming.