I know we’re all focused on the war in Europe—as we should be—but I thought I’d take a week to go full Andy Rooney and complain about television commercials. Specifically, I want to talk about the television commercials that more than any other really get under my skin: pharmaceutical ads.
Not to worry. If there’s a problem with my skin, Dupixent can heal it from within. Cyndi Lauper and I can trade stories about Cosentyx, and then we can sing about Otezla to the tune of the 1974 pop hit “Magic,” which is not as catchy as the Skyrizi song (written, I swear, by someone named Richard Cheese). At the end of it, I can emerge Tremfyant with…well, with Tremfya.
And that’s just for my skin. I haven’t even thought about my atrial fibrillation, HIV status, toe fungus, overly thick (or thin) blood, diabetes, Hep C, or my many cancers, none of which might matter if I am undergoing a manic-depressive phase or suffering from schizophrenia.
All of these conditions and more now have treatments marketed directly to the consumer. And that’s unhealthy.
Maybe I’m just getting old and overly sensitive about my health (which is, in general, not too bad for a man of my years and, shall we say, portly carriage). I take a handful of medicines every day, and I am grateful they exist. But I am hating these advertisements for prescription drugs on American television more than ever. If you wonder why we are a self-absorbed, querulous, neurotic society, it might have something to do with a barrage of ads meant to turn us into hypochondriacs who are determined to make our doctors prescribe us the thing we just saw.
Determined, that is, unless of course we have medullary thyroid cancer or tuberculosis, are pregnant, are about to be pregnant, are even thinking of getting pregnant, or have been to an area where fungal infections are common. Or if we’re allergic to whatever it is we’re about to demand, which we will probably find out about by having an allergic reaction. If that happens, and our tongue swells and our heart races, we’re supposed to call 911. But we won’t be able to call a lawyer, because we’ve already been warned that this miracle drug can cause just about anything, including death.
Look, I get it. Some ads are just icky, especially for supplements for everything from memory to testosterone. (Yes, I’m looking at you, Mayim Bialik, “actual neuroscientist.”) Their claims, as the makers are always quick to tell you, “have not been evaluated by the Food and Drug Administration” and “are not intended to diagnose, treat, cure, or prevent any disease.” I see all the worst ads because I’m a night owl and occasional insomniac. I fully understand that at 3 a.m., there will be ads for prostate cures, or for drug and alcohol rehab, or—duh—over-the-counter sleep medications. Why else would you be watching Mannix in the wee hours unless you had to pee, were on a bender, or were suffering from a sleep disorder? (For the record, I just happen to like watching old reruns. In the middle of the night, my comfort food is Voyage to the Bottom of the Sea and The Time Tunnel on MeTV.)
But pharmaceutical advertising has become a plague. A woman should be able to stream reruns of The Good Wife without being pummeled about how one more breast-cancer drug can buy her another 10 months of life. Indeed, maybe she’s watching those old reruns because she’d rather not think about her condition. On a far lesser scale, perhaps we might be able to get through just one dinner without an exhortation to bombard our bowels with Linzess or Humira.
Worse yet are the manipulative ads for psychiatric drugs to treat everything from mood disorders to schizophrenia. One ad for depression shows a child looking with deep concern at a crying mommy—because that’ll certainly help someone who’s depressed. Another shows a woman running around like Claire Danes’s bipolar CIA spook from Homeland, trying to do a million things, and then living a happy orderly life after another pill. And speaking of spooks, the makers of a drug called Fanapt actually mimicked the world of schizophrenics—complete with delusions of people staring at them and taking pictures of them—in order to market a drug to people with schizophrenia.
After all, triggering the worst fears of someone with a disability that involves troubles with perceptions of reality is clearly the best way to get them to have a rational conversation with their doctor about their condition.
The depression ads especially infuriate me. I have been treated for depression, and while I am grateful to live in a time where there are effective pharmacological treatments, not all of them are the right drug for everyone. I know from experience that it can take a few tries to get it right, and I was fortunate that I never saw—or paid attention to, anyway—a single ad when working with my doctors. Many of the ads about mood disorders are clearly aimed at women, and they rely on implied mommy-guilt; they make me want to throw a coffee cup at the television.
Maybe there’s something I can take for anger management.
Anyway, the net effect of all this advertising is that we’re prescribing more and more drugs to a nation that is, to judge from watching a random few hours of television, composed of depressed heart patients and diabetics who keep picking at their bad skin while running for the office bathroom to deal with their leaky bladders and spasming colons but can’t get in the door because their Parkinson’s tremors or their tardive dyskinesia keeps making them drop their keys.
I am not making light of any of these conditions. I am suggesting that flooding us with ads for conditions we have—and that many of us don’t have—is bad for our mental health, undermines the relationship between patients and doctors, and pollutes the public sphere with invitations to hypochondria.
The United States is one of only two countries on this planet that allow the direct advertising of prescription drugs. (The other is New Zealand, a small nation that is pretty reasonable about most things and can probably handle it.) It may surprise you—as it surprised me—to find out that advertising drugs was never actually illegal in the United States. Companies did it all the time, in medical journals and other magazines where they could reach doctors, and where they could include, in print, all the stuff required by the U.S. Food and Drug Administration about chemical structure, interactions, and risks.
The pharmaceutical companies didn’t run television ads, because it’s hard to fit all the disclaimers into a short spot, and they didn’t want the FDA to come down on them. But no one had really tested this until the European makers of ibuprofen—once upon a time, a prescription drug—tried it out with a few ads in Florida in the early 1980s. The FDA squawked, and the makers of the ad, knowing this would happen, fixed up a new one. But the FDA still insisted on long spiels about risks and warnings; on television, time is money, and so it didn't pay to run ads that would be taken up with long scrolling screens of side effects.
(These early rules did, however, inspire one of the funniest Saturday Night Live fake ads of all time. Remember: Do not taunt Happy Fun Ball.)
Drug marketing didn’t really take off until the late 1990s, when the pharmaceutical industries got a helpful “clarification” on TV rules from the FDA itself. That’s when things went bonkers. In 1997, according to NPR, drug companies spent $300 million on TV ads; a year later, spending doubled to $600 million. By 2000 it was over a billion and a half dollars. Today, it’s closer to $6 billion a year (although the drug companies still spend more advertising to doctors).
This has had an effect. American doctors are prescribing more drugs, even though it’s not clear that more prescriptions are doing us any good. And it’s inflaming the dangerous and narcissistic problem—one I wrote about in the book The Death of Expertise—that people think they know enough to tell their doctors what to do. As one M.D. put it to me, people no longer come in for a diagnosis of a problem; they walk in and say, “This is what I have, and this is what you’re going to prescribe.”
In an environment where patients are now consumers and consumer happiness is everything, there are plenty of doctors who will shrug and write the prescription.
There’s a simple answer for all this: Pass a law. If it requires a prescription, then you can’t put it on television. I’m not a lawyer, and I don’t know how to make this pass First Amendment muster—but if you can ban cigarette ads, there must be a way to not inundate people who have HIV, breast cancer, or bipolar disorder with constant high-speed babble about the promise of treatment and the risks of death.
Now if you’ll excuse me, I have some pills to take.