Disease-awareness ads lead to overdiagnosis, boost Rx sales

Ads that try to bring awareness of diseases boost prescription drug sales and overdiagnosis in the U.S., according to a new study.

There is a fine line between direct-to-consumer drug ads, which the Food and Drug Administration regulates, and ads meant to create disease awareness that often skirt the purview of the FDA, per the article published Thursday in JAMA.

Disease awareness advertisements, particularly for conditions that only have one approved drug treatment, can bolster drug sales and lead to "inappropriate" prescriptions as patients turn to their doctors and request the drugs they see advertised, researchers found.

A narrow selection of branded prescription drugs has been linked to rising healthcare costs that have strained the entire industry. Patent-protected, single-source drugs make up 63% of total drug spending, up from 29% of total spending in 2010, despite the fact that they make up less than 10% of total prescriptions filled, research shows.

U.S. patients pay twice as much for 54 of the top branded prescription drugs than other industrialized countries, said Dr. James Weinstein, president and CEO of Dartmouth-Hitchcock Health.

"The (healthcare) market is not working," Weinstein said Thursday at Northwestern University's Kellogg School of Management's Annual MacEachern Symposium for Healthcare. Despite more being spent, the U.S. has some of the worst outcomes compared to other industrialized countries in life expectancy, infant mortality and quality of primary care, he added.

Prescription drug price increases are, in part, making healthcare more expensive. Yet, the reasons behind drug price hikes are often masked by proprietary trade secrets, sales arrangements with middlemen and confidential rebates.

In 2016, drug companies spent $5.6 billion on direct-to-consumer ads in the U.S., researchers found. That was the industry's highest annual spending of all time.

While an absolute ban on advertising is unlikely, stricter regulation of disease awareness promotions would curb wasteful diagnostic testing, overdiagnosis and inappropriate therapy, researchers said. Direct-to-consumer pharmaceutical advertising should be regulated by law to ensure that consumers know the potential harms of additional testing or treatment, and the FDA should step in to better monitor these campaigns, they said.​

Some states have proposed legislation intended to limit or ban gifts that drug representatives give to doctors. Last week, the California state Senate passed a bill that restricts pharmaceutical companies from giving gifts including flights, speaking fees and consulting payments to physicians.

When providers limit drug reps' access to doctors, prescriptions shift from branded drugs largely toward cheaper generic, ultimately lowering healthcare costs, research shows.

Still, more work is needed to better control the rising cost of prescription drugs, researchers said.

"Ultimately, the status quo appears increasingly untenable: direct-to-consumer advertising is a massive medical intervention with unproven public health benefit, dubious plausibility and suggestive evidence of harm," the JAMA paper said.