Dancing with disease: When medicine meets marketing

Notes from the Heart by Fernando Riveron MD

Editor’s note: Dr. Fernando Riveron is well-known, now-retired heart surgeon in Wausau. We’re happy to have him writing this column, From the Heart, for The Wausonian. Enjoy!

It’s ironic that the happiest people we see on TV seem to be the ones with the most dreadful, miserable diseases. You know- the ones in the commercials dancing, playing, and singing in idyllic surroundings while telling you about their diabetes, cancer, arthritis or herpes.

Their lives seem so carefree and even enviable, despite their ailments, because they are taking some unpronounceable magic pharmaceutical drug. In fact, they insist, you need to ask your doctor to prescribe you some of this elixir so you too can romp blissfully through the Elysian Fields.

All the while, in the background, the subdued voice of mandatory corporate responsibility is rattling off a horrific list of potential side-effects, including stroke and death.

In reality, as a heart surgeon, I have never personally had a patient ask for any of these unmentionable drugs during an office visit. They (and I) are more likely to refer to these as the “what-cha-ma-call-it” I heard about on TV. Yet, the pharmaceutical industry spends billions each year to entice you with their happy pills or shots.

In 2024, total media spending by the pharmaceutical sector was estimated to be as much as $20 billion, with the great majority on television (75%). They account for such a large percentage of add revenue that “Big Pharma” wields a considerably oversized clout over linear (non-streaming) media.

So what gives? Is there sufficient return on investment for drug companies to incessantly entertain us with euphoric sick people line-dancing? Are there motives beyond education and public awareness?

The business of bliss

Direct to consumer advertising (DTCA) is a strategic investment. It boosts brand recognition, nudges patient awareness of the commonality of their infirmity and provides ostensibly easy (although expensive) solutions. They even provide us with a nomenclature of easier to pronounce and to remember acronyms: RA, COPD, PsA, UC, IBS, BPH… and of course ED. These are far less scary and have a gentler ring as your TV is blaring out a discussion of Irritable Bowel Syndrome or Erectile Dysfunction while you are passing the chips and salsa.

This is a highly effective branding strategy. It softens intimidating topics and medical jargon to digestible three letter packages that are easier to sell. The visual diversions with happy scenes are clearly a subliminal distraction in order to play down the potential dangers. Hey! Look how easy it is to lower my A1c!

It is notable that the FDA first approved direct to consumer broadcast advertising for pharmaceuticals in 1997. Globally this practice is permitted in only two countries: the United States and New Zealand.

The topic is particularly relevant because Robert F. Kennedy Jr., the newly appointed secretary of Health and Human Services, has stated that he would “advise President Donald Trump to ban pharmaceutical advertising on TV”. While such a ban would face significant legal and political challenges, including First Amendment concerns, it underscores a growing scrutiny of the potentially misleading and injurious impact of these ads on public health.

The doctor will see your wishlist now

Despite my personal experience that patients have worries beyond elective medications when they are contemplating heart surgery, it turns out these cleverly packaged advertisements are highly effective.

One survey revealed that physicians filled 69% of patient requests for interventions prompted by DTCA despite considering them marginally appropriate. Another study found physicians complied with DTCA driven requests 77% of the time.

So, consider the immense coercive power of patients looking to their physicians to relieve them of their maladies with an easy panacea. Or perhaps this speaks to the doctor’s desire to appease patients or simply get them out of their hair.

Ethics on aisle one

Should complex and potentially dangerous drugs be marketed directly to the public as if they were soda or shampoo?

On one hand, DTCA can benefit consumers by raising awareness. Patients can be spurred to seek help for symptoms they might otherwise ignore or deny. That’s a huge win.

On the other hand, these ads tend to promote more expensive drugs; often before the long term data is fully understood. Of the top 150 best selling drugs those rated by physicians as having “lower added benefit” for a particular condition and those already having the highest total volume of drug sales were associated with the largest proportion of total promotional spending.

Perhaps the goal is not better health; it’s better margins. When healthcare becomes a commercial transaction, there is a risk that patients may become manipulatable consumers rather than partners in achieving better health. Finally, there is a moral hazard involved in implying easy and quick solutions to health issues that should include more disciplined or difficult changes in our behavioral patterns. The easy way out is rarely the best in the long term.

So should we change the channel?

Medical advertising is a hot controversial issue. While it can empower patients to be more involved in their care, it risks turning science- based therapy into marketing and treatment into a trend.

Is the purpose education or manipulation? Perhaps the great underlying problem — the real question we need to ask — is how do we access honest and reliable information on health, nutrition and and medical care?

There is a great need in our culture for dependable education and improved knowledge on these vitally important topics. Imagine the beneficial impact on our lives and on society as a whole. How can we respond to pharmaceutical advertising in a way that has a positive impact on our health?

Start by treating these ads as what they are: marketing, not medical advice. If a commercial introduces you to a condition or treatment you hadn’t considered, use it as a springboard for a thoughtful discussion with your doctor.

But please don’t stop there. Ask about non-drug alternatives that may offer similar benefits, such as dietary changes, exercise, cognitive behavioral therapy, or evidence-based integrative approaches. Many chronic conditions respond well to lifestyle interventions that carry fewer risks and have longer-term benefits.

When speaking with your doctor, aim for curiosity, not coercion. A good clinician will help weigh the options objectively, not just default to the suggested drug-of-the-month.

Your doctor should be treated as a great resource not an expedient conduit. After all, your treatment plan should be guided by evidence—not emotionally lit backdrops and slick advertising.

So, the next time an actor in idyllic surroundings tells you to go “ask your doctor,” ask yourself if this is medical advice or an expensive sales pitch? Finally, stop and consider that when the side effects include “sudden death” maybe you should hold off on the dancing.

References:

1)“Why Pharma and Healthcare Advertising Continues to Rise”, Health-Union.com https://health-union.com/blog/digital-ad-spend-increasing-in-healthcare/

2) “The State of Pharmaceutical Advertising”, XR Research https://www.xr.global/blog/the-state-of-pharmaceutical-advertising

3) “Association between Drug Characteristics and Manufacturers Spending on Direct to Consumer Advertising”, JAMA. 2023 Feb 7;329(5):386-392. https://jamanetwork.com/journals/jama/fullarticle/2801060

4) “How Direct to Consumer Adds Hook Us” Harvard Health Publishing, March3, 2022 https://www.health.harvard.edu/blog/harvard-health-ad-watch-how-direct-to-consumer-ads-hook-us-201909201968

5) “Direct to Consumer Pharmaceutical Advertising, Physician and Public Opinion and PotentialEffects on the Physician Patient Relationship”, JAMA Internal Medicine, Feb. 23, 2004 https://pubmed.ncbi.nlm.nih.gov/14980994/

6) “Direct to Consumer Advertising: Physicians Views of It’s Effect on Quality of Care and the Doctor- Patient Relationship”, J of the American Board of Family Practice, Feb. 11, 2004 https://www.jabfm.org/content/16/6/513

7)“Lifestyle Medicine: An Evidence-Based Approach to Prevention and Treatment”. American College of Lifestyle Medicine 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10176046/