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If extraterrestrial intelligence is monitoring American drug commercials from outer space, they could be forgiven for concluding that human couples reproduce while sitting in separate bathtubs.

Most heavily advertised medication in the history of either medicine or television

The image of a happy couple holding hands watching the sun set while contemplating sexual intercourse later has become the trademark for the erectile dysfunction drug Cialis. Next to cholesterol medication Lipitor, Cialis has become the single most heavily advertised medication in the history of either medicine or television.

Do drug commercials really sell drugs?

Drug commercials, however, are not responsible for the profits of the bestselling drugs. Consider this list of the ten medications receiving the most advertising dollars in the United States in 2009:

1. Lipitor (for high cholesterol)
2. Cialis (for erectile dysfunction)
3. Abilify (for bipolar disorder, schizophrenia, and major depression)
4. Cymbalta (for depression, and, outside the United States, for urinary stress incontinence, fibromyalgia, pain from diabetic neuropathy, and chronic fatigue syndrome)
5. Plavix (to prevent blood clotting)
6. Symbicort (for asthma and chronic obstructive pulmonary disease)
7. Lyrica (for spinal cord injury, certain seizure disorders, and fibromyalgia)
8. Advair (for asthma and chronic obstructive pulmonary disease)
9. Viagra (also for erectile dysfunction)
10. Crestor (also for high cholesterol)

Also consider the Nielssen survey list of the medications most remembered from TV commercials during the same period:

1. Flomax (for prostate problems)
2. Gardasil (for prevention of infection with certain strains of human papillomavirus, also known as HPV).
3. Pristiq (for treatment of symptoms of menopause)
4. Aricept (for Alzheimer's disease)
5. Cialis (for erectile dysfunction)
6. Orencia (for rheumatoid arthritis)
7. Plavix (for prevention of blood clotting disorders) and
8. Viagra (also for erectile dysfunction)

The message from the Nielssen ratings of drug commercials seems to be that American viewers have watched all the Lipitor, Abilify, Advair, and Crestor commercials they ever want to see (although an argument can also be made for fewer future Cialis and Viagra commercials). Pharmaceutical industry data shows that Americans may simply not be as interested in taking newer and better medications as they once were.

The market for prescription drugs is greater in the USA than in any other country

In 2009, sales of prescription medication in the United States totaled $252 billion, about 5 per cent more than the year before.

Sales of prescription medications in China, Russia, South Korea, and Mexico, however grew 81 per cent during the same time period—even without the clever advertisements showing the happy couple sitting in separate bathtubs watching the sun go down.

Drug commercials really sell drugs, but they only sell drugs that are new to the audiences viewing them. And the most heavily marketed drugs are not necessarily heavily advertised. Consider a third list, naming the ten bestselling drugs in the US last year:

1. Lipitor (for high cholesterol), $8.4 billion in sales in 2009.
2. Zocor (also for high cholesterol), $4.4 billion in sales in 2009.
3. Nexium (for heartburn), $4.4 billion in sales in 2009.
4. Prevacid (for heartburn), $3.8 billion in sales in 2009.
5. Advair Diskus (for asthma), $3.6 billion in sales in 2009.
6. Plavix (for preventing of clotting disorders), $3.5 billion in sales in 2009.
7. Zoloft (for depression), $3.1 billion in sales in 2009.
8. Epogen (for anemia), $3.0 billion in sales in 2009.
9. Procrit (for anemia), $3.0 billion in sales in 2009.
10. Aranesp (for anemia), $2.8 billion in sales in 2009.

Although Lipitor, Nexium, and Plavix sales were supported by substantial advertising dollars, the other medications on this list of bestsellers were primarily chosen by doctors rather than requested by patients. What doctors think of a drug, it appears, is actually much more important in the long run than what patients believe is new.

Drug advertising directed at doctors is not necessarily better

Pharmaceutical companies, of course, also advertise to doctors, primarily in medical journals. In most countries, pharmaceutical companies have no incentive to misrepresent the uses of their drugs. Medications are either allowed or prohibited based on a formulary used by all doctors and all drugstores.

In some countries, however, doctors, rather than national health services, choose medications. In these jurisdictions, pharmaceutical companies have incentive to make exaggerated claims.

A review of advertisements directed at doctors found that 25 per cent of drug ads directed at doctors in Brazil would lead to inappropriate prescribing if the doctor relied only on the information in the advertisement. The same study found that 38 per cent of drug advertisements directed at doctors in Pakistan were misleading. Reviewers have found that 44 per cent of the advertisements American doctors read are misleading and can cause inappropriate prescribing, and a study of advertising in Indian medical journals found that all of the ads in those journals made claims that could not be supported by research the companies had performed on their drugs.

Should patients "buy" drugs just because commercials sell them?

New medications for conditions that previously had no medications usually bring vast improvement to patient's lives. Lyrica, the first approved prescription medication for fibromyalgia, for example, has tremendously improved the lives of thousands of sufferers of the disease. It does not completely control symptoms, and it is not free of side effects, but it is a great deal better than getting no medication at all.

New medications that replace old medications seldom represent real advances in treatment. The drugs Rezulin, Actos, and Avandia, for example, were promoted as a virtual "cure" for type 2 diabetes. Rezulin was taken off the market when hundreds of people suffered liver failure. Actos and Avandia were later revealed to help control blood sugar levels by turning baby bone cells into baby fat cells (that absorb sugar from the bloodstream), making weight harder to control and bones easier to break.

If you are already taking a medication for a health condition, chances are you should simply ignore television commercials. Adjusting the medication you currently take is the fastest way to get relief over symptoms. And especially if your doctor comes in the examination room with a new tan acquired a drug company presentation in Hawaii, make sure the drugs you take are for your benefit, not your doctor's.

  • Frosch DL, Grande D. Direct-to-consumer advertising of prescription drugs. LDI Issue Brief. 2010 Mar-Apr,15(3):1-4
  • Othman N, Vitry A, Roughead EE. Quality of pharmaceutical advertisements in medical journals: a systematic review. PLoS One. 2009 Jul 22,4(7):e6350