Adverse Effects of Pharmaceutical Marketing 

  There has always seemed to be an inherent ethical conflict in advertising medications. Why should companies have to advertise their drugs? Shouldn’t success come from the curing of patients rather than the creativity of an advertising executive? In their 2009 paper “The Effects of Pharmaceutical Marketing and Promotion on Adverse Drug Events and Regulation,” Guy David of the University of Pennsylvania, Sara Markowitz of Emory University, and Seth Richards, also of the University of Pennsylvania, attempt to address this question by analyzing the effects of pharmaceutical marketing and promotion on company revenues and behavior.
The growth of pharmaceutical advertising is a fairly recent phenomenon, and much of it took place after the FDA changed regulations regarding advertising in 1997. In prior years, companies were allowed to contact doctors, hold seminars and conferences, but not permitted to advertise commercially. Since then, advertising expenditures have soared from 9.1 billion to 26 billion dollars. Because advertising spending is positively correlated with revenue, it would appear that companies have a strong incentive to advertise heavily in order to maximize their revenues and, in turn, their return on investment in drug research.
On the one hand, drugs for ailments for which there is a relatively simple screening process, such as allergies or high cholesterol, tend to show a positive correlation between advertising expenditures and the reduction of adverse health effects. At first glance then, the solution seems simple: spend heavily on advertising and reap the benefits. However, heavy advertising also tends to attract less and less well-matched patients to the drug. Such improper prescription or use of the drug can lead to adverse health effects including death and hospitalization. While it is difficult for the FDA to definitively blame a particular drug as a cause of death rather than a confluence of medical conditions and inherent risks, it does raise the specter that the FDA will recall the drug and take it off the market.

   Complicating matters further is the idea that the benefit of advertising can extend beyond merely generating sales for a drug. Advertising can also motivate patients who may have not sought treatment to go to a doctor, though these indirect health effects are difficult to measure. But there are adverse welfare effects as well: pharmaceutical advertising tends to push newer and more expensive drugs to the forefront of prescription lists while pushing older, yet equally effective and cheaper drugs to the back. Worse still, sometimes the newer drugs are not more effective and sometimes not as well-matched to the patients.
After weighing higher revenues against the damages caused by poor drug-matching, the authors recommend a middle course: for drugs used to cure relatively common ailments that can be easily tested for, extensive post-market regulation may not be necessary. For drugs used to treat conditions that necessitate screening beyond a visit to one’s doctor, however, post-market regulation may be prudent in order to ensure that prescription drugs contribute rather than detract from the improvement of public health.